TRALI (Transfusion Related Acute Lung Injury)

A 61-year-old woman with advanced non small cell lung cancer developed an intestinal tract bleeding. She received two bags (600 mL) of plasma- and leukoreduced red blood cells (RBCs) on hospital day 1. No apparent complications were observed within 6 hours after transfusion; however, 48 hours after the transfusion, sudden development of dyspnea and rapid progression of hypoxemia were observed. A chest radiograph showed bilateral diffuse pulmonary infiltrates without cardiomegaly. B-type natriuretic peptide levels were within the normal limits.There was no evidence of infection in the lungs. Methylprednisolone sodium succinate was administered for pulmonary edema, but pulmonary infiltrates and hypoxemia continued to worsen. On day 23, chest radiography showed a significant improvement in pulmonary shadows. On day 32, due to a bleeding intestinal tract, an additional transfusion of two bags of RBCs was performed and, on day 34, there was a rapid deterioration of the respiratory condition again. Bilateral pulmonary infiltrates were again observed on a chest radiograph. The patient died of multiple organ failure the next day.