TRALI (Transfusion Related Acute Lung Injury)

Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
54 of 86 patients (63%) with a mean age of 67.6 years old undergoing extensive surgery developed respiratory failure (PaO2/FiO2 <300mmHg) after intraoperative apheresis platelet transfusion. 23 cases diagnosed as TACO (26.7%) based on acute hydrostatic pulmonary edema diagnosed by the presence of perihilar vascular engorgement and/or mediastinal enlargement on chest x-ray within 6 hours. Multivariate logistic regression showed age (OR=1.146) and presence of anti-HLA class II antibody in the transfused platelets (OR= 18.4) as significant independent predictors of TACO.
Time to detection: 
< 6 hours
Alerting signals, symptoms, evidence of occurrence: 
Active surveillance within 6 hours of platelet transfusion. Respiratory failure defined as PaO2/FiO2 <300mmHg. Independent. All enrolled patients had chest xrays evaluated by independent radiologist for the presence of permeability pulmonary edema or hydrostatic pulmonary edema.
Demonstration of imputability or root cause: 
Gajic et al 2006 guidelines for the diagnosis of TACO and Ely et al. 2001 for criterion of circulatory overload. Consult with anesthesiologist and intensivist, final diagnosis by radiologist.
Suggest references: 
Kanai R, Iijima T, Hashimoto S, et al. Impact of immunoreactive substances contained in apheresis platelet concentrate on postoperative respiratory function in surgical patients receiving platelet transfusion: a prospective cohort study. Transfus Med. 2013 Oct;23(5):344-50