A 42-year-old woman receives a blood transfusion for anaemia secondary to heavy vaginal bleeding. 4 hours after commencement of the transfusion she complains of feeling breathless and has developed a dry cough. Her temperature is measured at 38.1ºC. A chest X-ray is taken and is shown below:
This patient has suffered a transfusion-related lung injury (TRALI), which is a form of acute respiratory distress thought to be caused by the donor plasma containing antibodies against the patient’s leukocytes.
It is defined as hypoxia and bilateral pulmonary oedema occurring within 6 hours of a transfusion in the absence of other causes, such as cardiac failure or volume overload.
The commonest clinical features of TRALI are:
- Cough (can be non-productive)
- Frothy sputum
- Hypotension or hypertension