Transfusion-related acute lung injury (TRALI), during malaria treatment

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
TRALI is a rare but potentially fatal complication of blood product transfusions, which occurs in one about 5000 transfused blood components. The reported numbers may not reflect the real incidence rates due to unfamiliarity with the syndrome.
Time to detection: 
Shortly after completing the transfusion of a plasma unit.
Alerting signals, symptoms, evidence of occurrence: 
A 29-year-old-male resident of Turkey was admitted to a hospital 15 days after returning from Burkina Faso with high fever and sweating. The patient was diagnosed in a previous hospital with malaria and treated with chloroquine for a total of 6 days. When admitted in the second hospital his general condition was poor. P. falciparum sporozoites were observed in blood film examination. Treatment with intramuscular injection of artemether was started. The patient suddenly developed respiratory failure after being given a unit of fresh frozen plasma because of the prolongation of prothrombin time. Oxygen saturation was 85% in room air. Chest radiograph revealed bilateral diffuse opacities, and the patient's echocadiography findings were normal. The patient was transferred to the intensive care unit (ICU), and his breathing improved gradually under non-invasive ventilatory support in 48 hours. He was then transferred to inpatient ward. He was discharged on the 18th day.
Demonstration of imputability or root cause: 
The case was diagnosed with TRALI because respiratory problems were developed soon after plasma transfusion (lower than 90% oxygen saturation within 6 hours) and bilateral effusion was observed on chest radiograph, echocardiographic findings were normal, and symptoms were healed with 48 hours of support treatment, while all lung indicators were normal before the transfusion of fresh frozen plasma to support the treatment of the serious P. falciparum case.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Reference attachment: 
Suggest references: 
TRALI Syndrome During the Treatment of a Plasmodium falciparum Malaria Case. Turkiye Parazitol Derg. 2016 Dec;40(4):205-207.
Expert comments for publication: 
TRALI diagnosis based on clinical factors only; no anti-HLA or anti-neutophil antibody studies performed.