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While hiking on a trail follow these Trail Safety Rules:
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- Observe caution when walking near cliff edges or on rough terrain. ...
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- Use the guide or map provided for the route. ...
- Never build new cairns or change the trail markers. ...
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Trail is defined as to drag, pull, follow or lag behind someone or something. An example of trail is to walk behind someone. To lag behind (an opponent). Trailed the league leader by four games.
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The Spirit Trail is a collaboration between The City, First Nations, North Shore municipalities, and the provincial and federal governments.
What is a trali?
What are the two hypotheses that lead to neutrophil activation in TRALI?
What are the two events that are associated with trici?
Does inflammation increase the risk of tali?
Is there a test for trila?
Is transfusion of even part of one unit associated with trilli?
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What causes a TRALI?
TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigens (HLA) or human neutrophil antigens (HNA).
What are the signs and symptoms of TRALI?
TRALI is a well-characterized clinical constellation of symptoms including dyspnea, hypotension, and fever. The radiological picture is of bilateral pulmonary infiltrates without evidence of cardiac compromise or fluid overload.
What happens in TRALI?
[1] Transfusion-related acute lung injury (TRALI), is a clinical syndrome in which there is acute, noncardiogenic pulmonary edema associated with hypoxia that occurs during or after a transfusion. [2] It is the leading cause of death from transfusion documented by the U.S. Food and Drug Administration (FDA).
When does a TRALI occur?
Transfusion-related acute lung injury (TRALI) is defined as new acute lung injury (ALI) that occurs during or within six hours of transfusion, not explained by another ALI risk factor. Transfusion of part of one unit of any blood product can cause TRALI.
Who is at risk for TRALI?
Conclusions: The risk factors for TRALI in this study included Number of transfusions and FFP units were positively correlated with TRALI. Age, female sex, tobacco use, chronic alcohol abuse, positive fluid balance, shock before transfusion, ASA score and mechanical ventilation may be potential risk factors for TRALI.
What is the difference between TRALI and TACO?
TACO is characterized by pulmonary hydrostatic (cardiogenic) edema, whereas TRALI presents as pulmonary permeability edema (noncardiogenic). The pathophysiology of both syndromes is complex and incompletely understood.
What is the mortality rate of TRALI?
Among immediate transfusion reactions, TRALI is singular in its mortality rate. Only hemolytic transfusion reactions due to ABO incompatibility are comparable. The reported fatality rate is 5–24%. The most widely cited figure is 5–10% [3].
How do you reduce the risk of TRALI?
There have been several other suggestions for preventing TRALI, which include:Screening of all donors for anti-neutrophil or anti-HLA antibodies. ... Use of pre-storage leukoreduced blood. ... Appropriate utilization of blood products.
What causes TACO and TRALI?
Transfusion-specific risk factors for TRALI and TACO include the total number of blood products administered, regardless of component type. Plasma from a previously pregnant blood donor is a well-established risk factor for TRALI due to pregnancy-related alloimmunization (ie, development of antileukocyte antibodies).
How often does TRALI occur?
TRALI is an uncommon syndrome, that is due to the presence of leukocyte antibodies in transfused plasma. It is believed to occur in approximately one in every 5000 transfusions.
Why does TACO happen?
Transfusion-associated circulatory overload (TACO) is a common transfusion reaction in which pulmonary edema develops primarily due to volume excess or circulatory overload.
Can TRALI be delayed?
Although TRALI is defined as occurring within six hours of blood product transfusion, this case highlights the possibility of a delayed presentation of TRALI to the ED if the initial respiratory symptoms are not recognized.
How do you diagnose TRALI?
The blood products are sent for Gram staining and culture if signs of sepsis are present. If the symptoms indicate hypoxemia and/or respiratory failure, the diagnosis of TRALI is suspected; all blood products related to the implicated unit are quarantined and the TS Medical Director is notified.
Which signs and symptoms are potential indications of acute circulatory overload?
Transfusion-associated circulatory overload is characterised by acute respiratory distress, tachycardia, increased blood pressure, acute pulmonary oedema and/or evidence of positive fluid balance occurring within 6 hours after transfusion.
Which blood product is most implicated in TRALI?
TRALI is a clinical syndrome that occurs within 6 h of transfusion and is characterized by shortness of breath due to noncardiogenic pulmonary edema, fever and hypotension. TRALI can be seen with any blood products, but most often plasma or platelets are implicated.
What causes TACO and TRALI?
Transfusion-specific risk factors for TRALI and TACO include the total number of blood products administered, regardless of component type. Plasma from a previously pregnant blood donor is a well-established risk factor for TRALI due to pregnancy-related alloimmunization (ie, development of antileukocyte antibodies).
TACO and TRALI: prevention, diagnosis and management
CE Chapman Antibodies to white cells repeatedly implicated in TRALI since 1957 specificities include HLA class I, HLA class II and human neutrophilantigens (HNA)
Mechanisms of transfusion-related acute lung injury (TRALI): anti ...
There is abundant evidence that leukocyte antibodies in blood donor products are somehow involved in transfusion-related acute lung injury (TRALI). Human leukocyte antigen (HLA) class I, HLA class II, and neutrophil-specific antibodies in the plasma of both blood donors and recipients have been impl …
TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) - Microsoft
INFORMATION INF271/3.4 Effective: 12/01/16 Transfusion Related Acute Lung Injury (TRALI) Author: Tom Latham Page 3 of 10 if eligible. A donor who is found to have HNA antibodies with an identified HNA specificity is
Transfusion-related acute lung injury - Wikipedia
Transfusion-related acute lung injury (TRALI) is the serious complication of transfusion of blood products that is characterized by the rapid onset of excess fluid in the lungs. It can cause dangerous drops in the supply of oxygen to body tissues. Although changes in transfusion practices have reduced the incidence of TRALI, it was the leading cause of transfusion-related deaths in the United ...
Transfusion Related Acute Lung Injury (TRALI) | FDA
This is to alert you to the possibility that patients who receive blood products, particularly plasma-containing products, may be at risk for Transfusion Related Acute Lung Injury (TRALI), a ...
Transfusion-related acute lung injury (TRALI) - Professional Education
Historically, Canadian Blood Services defined TRALI using the 2004 Canadian Consensus Conference Panel definition (Table 2). In 2012, the definition of ARDS (known as the Berlin definition) was revised resulting in removal of the term acute lung injury (ALI) among the critical care community internationally.
What is a trali?
Transfusion-related acute lung injury (TRALI) is a syndrome of acute lung injury (ALI) associated with transfusion. The term TRALI was coined by Drs. Popovsky and Moore when they reported a case series at the Mayo Clinic in 1985 (1). In this case series, the typical clinical presentation included acute respiratory distress characterized by hypoxemia and fulminant pulmonary edema. The onset was usually within 4 hours of transfusion and was often accompanied by fever, tachycardia, hypotension or hypertension. In most patients (81%), recovery was rapid and complete. The incidence was 1:5,000 units transfused and the TRALI patients were comprised of mainly surgical patients. There is still no consensus on the incidence, pathogenesis or laboratory diagnosis of the syndrome. However, reports of TRALI are increasing due to increasing awareness of the syndrome, although underreporting is still strongly suspected. An analysis of the United States Food and Drug Administration fatality reports for the last three fiscal years showed bacterial contamination, TRALI, and ABO hemolytic reactions to be the leading causes of deaths from transfusion. TRALI became the leading cause of fatalities reported to the FDA in fiscal 2003. Fatalities were associated with fresh frozen plasma (FFP), red blood cells (RBCs) or platelets (2). Based on these data, it is clear that TRALI is one of the most significant complications of modern blood transfusion. This paper reviews what is known and unknown regarding the definition, mechanisms, incidence and clinical relevance of the syndrome.
What are the two hypotheses that lead to neutrophil activation in TRALI?
In the past two decades, two hypotheses that lead to neutrophil activation in TRALI have been proposed: antigen-antibody hypothesis versus the two-event hypothesis. Recipient factors that may be involved in the pathogenesis include the recipient’s underlying condition and genetic predisposition. Donor unit factors that may be involved in the pathogenesis include leukocyte antibody, cytokines, lipids and factor(s) that increase pulmonary endothelial cell permeability. These hypotheses and factors are discussed below.
What are the two events that are associated with trici?
The second event is transfusion of mediators, such as lipids and cytokines from stored blood products , which can prime or directly activate neutrophils, leading to pulmonary damage. These lipids include lysophosphatidylcholines, which are released from apoptotic white blood cells and platelets and have the capacity to enhance neutrophil function (32).
Does inflammation increase the risk of tali?
In both hypotheses (either direct antibody mediated activation or the two-event mechanism), it is quite likely that underlying risk factors in patients, including surgery or inflammation, enhance the risk of TRALI reactions. Inflammation has been associated with upregulation of HLA and neutrophil antigens, thus increasing the number of targets for transfused antibody and potentially increasing the probability that transfused antibodies can directly activate neutrophil function(33, 34). In addition, inflammation may upregulate vascular adhesion molecules such as P, E-selectin and ICAM-1, which in turn will facilitate accumulation of neutrophils in tissues. TRALI may occur if a second hit (ie transfusion of a lipid mediator or cytokine) enhances or directly activates neutrophil function - rapid injury of tissues, such as pulmonary parenchyma, containing the accumulated neutrophils would ensue.
Is there a test for trila?
Currently there is no definitive laboratory test for the diagnosis of TRALI. Leucopenia or neutropenia has been observed in case reports (6-12) but has not been studied in small case series (1, 13). Leukocyte antigen-antibody match between donor and recipient (HLA class I or II, granulocytes or monocytes), and neutrophil priming activity in donor blood have been reported but are not diagnostic (14)
Is transfusion of even part of one unit associated with trilli?
Transfusion of even part of one unit has been associated with TRALI
What is a trali?
Transfusion-related acute lung injury (TRALI) is a rare but serious syndrome characterized by sudden acute respiratory distress following transfusion. It is defined as new, acute lung injury (ALI) during or within six hours after blood product administration in the absence of temporally-associated risk factors for ALI. All plasma-containing blood products have been implicated in TRALI, including rare reports with IVIg and cryoprecipitate. Despite the very small amount of plasma contained in red blood cells, this product is associated with the largest number of reported cases of TRALI. TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigen (HLA) or human neutrophil antigen (HNA), in most cases. Non-antibody-mediated cases occur and may be mediated by biologic response modifiers present in the transfused blood product, along with recipient factors.
How to diagnose TRALI?
In order to correctly and consistently diagnose TRALI, the following information must be included in the adverse reaction report: 1 Timing of transfusion with respect to symptom onset 2 Presence of other risk factors for acute lung injury (Table 1) 3 CXR findings 4 Evidence of hypoxia: PaO 2 or SaO 2 5 Clinical indicators of volume status such as clinical evaluation, response to diuretics (if given), or where available JVP, PCWP, CVP, echocardiogram report, etc.
How long does it take for a TRALI to recover?
However, with supportive care, the lung injury is generally transient, with oxygen levels returning to pre-transfusion levels within 48 to 96 hours and CXR returning to normal within 96 hours. However, some patients are slower to recover and may remain hypoxic with persistent pulmonary infiltrates for several days although pulmonary function eventually returns to baseline without apparent sequelae. As with ARDS, there is no role for diuretics or corticosteroids.
What is TAD in a transfusion?
TAD is an acute respiratory distress occurring within 24 hours of transfusion which fails to meet criteria for TRALI, TACO, or anaphylactic transfusion reaction.
Does a trilli occur in all recipients of blood components?
Many studies in the literature support this hypothesis, 4-7 which may explain how some TRALI reactions occur in the absence of donor-derived anti-HLA/HNA antibodies, or why TRALI reactions do not occur in all recipients of blood components from donors who are known to have these antibodies. That is, in the absence of neutrophil priming by recipient factors, TRALI will not occur despite the transfusion of antibodies or biologic response modifiers.
Is a trili patient data form mandatory?
In order to correctly and consistently diagnose TRALI, the completion and submission of Canadian Blood Services’ TRALI Patient Data Form, is mandatory. For further details on submitting the TRALI Patient Data Form and possible patient samples for TRALI investigation, please refer to Canadian Blood Services customer letter CL 2021-01. In general, the following clinical information is requested by Canadian Blood Services:
What is a trili?
Transfusion-related acute lung injury ( TRALI) is a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema presenting with hypoxia following transfusion of blood products.
When does trici occur?
TRALI is defined as an acute lung injury that is temporally related to a blood transfusion; specifically, it occurs within the first six hours following a transfusion.
What is the diagnosis of trici?
It is a diagnosis upon examination of clinical manifestations that appear within 6 hours of transfusion, such as acute respiratory distress, tachypnea , hypotension, cyanosis, and dyspnea. TRALI is an uncommon syndrome, that is due to the presence of leukocyte antibodies in transfused plasma. It is believed to occur in approximately one in every 5000 transfusions. Leukoagglutination and pooling of granulocytes in the recipient's lungs may occur, with release of the contents of leukocyte granules, and resulting injury to cellular membranes, endothelial surfaces, and potentially to lung parenchyma. In most cases leukoagglutination results in mild dyspnea and pulmonary infiltrates within about 6 hours of transfusion, and spontaneously resolves.
What is a trali?
Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related morbidity and mortality. These adverse events are characterized by acute pulmonary edema within 6 hours of a blood transfusion and have historically been difficult to study due to underrecognition and nonspecific diagnostic criteria. However, in the past decade, in vivo models and clinical studies utilizing active surveillance have advanced our understanding of their epidemiology and pathogenesis. With the adoption of mitigation strategies and patient blood management, the incidence of TRALI and TACO has decreased. Continued research to prevent and treat these severe cardiopulmonary events is focused on both the blood component and the transfusion recipient.
What is the role of inflammation in TRALI?
In addition to cognate antibody exposure, systemic inflammation in the transfusion recipient is thought to be critical to TRALI pathogenesis by priming neutrophils and activating pulmonary endothelial cells.57-59The role of pretransfusion inflammation as part of a “2-event hypothesis” is supported by murine models of TRALI, in which an inflammatory response related to lipopolysaccharide or other stimuli (first event) is often required for HLA antigen/antibody interactions (second event) to induce lung injury.50,60Elevations in inflammatory cytokines interleukin-6 (IL-6), IL-8, and C-reactive protein before transfusion have been associated with the development of TRALI; the latter was also shown to enhance TRALI when administered in a murine model.20,61-63Systemic inflammation induces the expression of adhesion molecules on endothelial cells (CD62, ICAM-1) and neutrophils (PSGL-1), increasing interaction with peripheral granulocytes and resulting in intrapulmonary leukostasis.
Does TRALI occur in transfused blood?
However, the majority of transfused blood products that contain HLA antibodies do not cause TRALI, even when a cognate recipient antigen is present.38In one study, TRALI occurred in only 3% of recipients who received blood products from donors that had previously been implicated in cases of TRALI.54It was hypothesized that TRALI induction required sufficient quantity of antibody as determined by the volume of plasma transfused as well as the antibody class and strength (threshold hypothesis). In a multivariable analysis, the strength of cognate HLA class 2 antibody and the volume of HNA antibody were strong predictors of TRALI, with less evidence supporting the role of HLA class 1 antbodies.1,55However, all classes of cognate antibody exposure have been associated with severe and fatal cases of TRALI.56
Is TRALI a non-antibody?
In ∼20% of TRALI cases, HLA and HNA antibodies are not identified in the transfused product, despite the use of sensitive assays.71,72These cases of “nonantibody-mediated” TRALI may be due to unidentified antibodies or exposure to other biological reactive molecules (BRMs) within the transfused blood component administered. In parallel to donor leukocyte antibodies in the 2-event hypothesis for antibody-mediated TRALI, BRMs are thought to be the necessary stimuli to trigger the cascade of lung injury in a primed transfusion recipient. Cases of TRALI associated with RBC transfusion are infrequently associated with antileukocyte antibodies; instead, inflammatory factors in the supernatant of RBCs are thought to play a role in the pathogenesis in these cases. The contribution of inflammatory mediators to development of nonimmune TRALI is partially supported by retrospective, observational data showing a decline in the incidence of TRALI after universal leukoreduction.73,74However, in vitro evidence showing accumulation of leukocyte-derived inflammatory cytokines, soluble CD40 ligand, and nonpolar lipids (lysophosphatidylcholines) with prolonged RBC and platelet storage is not supported by case-control studies of human TRALI.1,42,75-80Ongoing research of nonantibody-mediated TRALI is focused on the role of blood donor characteristics and component manufacturing methods.81,82
Is TRALI a human or murine model?
Murine models and human studies support an antibody-mediated basis for TRALI. Donor leukocyte antibodies present in the plasma of a transfused blood component are postulated to bind to cognate (ie, corresponding) antigen in the recipient, resulting in capillary leak and lung injury.
Is TRALI associated with RBC?
Cases of TRALI associated with RBC transfusion are infrequently associated with antileukocyte antibodies; instead, inflammatory factors in the supernatant of RBCs are thought to play a role in the pathogenesis in these cases.
What antibiotics are used in TAS?
As maintaining renal perfusion is the primary goal during hemolytic reaction, furosemide as well as crystalloids may be used to induce forced diuresis. 3 In TAS, empiric antibiotic coverage can include vancomycin and a broad-spectrum beta-lactam such as piperacillin/tazobactam.
Is trici a pulmonary edema?
TRALI is described as a non-cardiogenic pulmonary edema thought to be secondary to increased vascular permeability because of host neutrophils that become activated by substances in donated blood. 5 Though the reaction will often resolve spontaneously over days, the patient may require intensive airway support, including intubation, until it does. 2 Diuresis is generally less effective in cases of TRALI.
What is a trali?
Transfusion-related acute lung injury (TRALI) is a syndrome of acute lung injury (ALI) associated with transfusion. The term TRALI was coined by Drs. Popovsky and Moore when they reported a case series at the Mayo Clinic in 1985 (1). In this case series, the typical clinical presentation included acute respiratory distress characterized by hypoxemia and fulminant pulmonary edema. The onset was usually within 4 hours of transfusion and was often accompanied by fever, tachycardia, hypotension or hypertension. In most patients (81%), recovery was rapid and complete. The incidence was 1:5,000 units transfused and the TRALI patients were comprised of mainly surgical patients. There is still no consensus on the incidence, pathogenesis or laboratory diagnosis of the syndrome. However, reports of TRALI are increasing due to increasing awareness of the syndrome, although underreporting is still strongly suspected. An analysis of the United States Food and Drug Administration fatality reports for the last three fiscal years showed bacterial contamination, TRALI, and ABO hemolytic reactions to be the leading causes of deaths from transfusion. TRALI became the leading cause of fatalities reported to the FDA in fiscal 2003. Fatalities were associated with fresh frozen plasma (FFP), red blood cells (RBCs) or platelets (2). Based on these data, it is clear that TRALI is one of the most significant complications of modern blood transfusion. This paper reviews what is known and unknown regarding the definition, mechanisms, incidence and clinical relevance of the syndrome.
What are the two hypotheses that lead to neutrophil activation in TRALI?
In the past two decades, two hypotheses that lead to neutrophil activation in TRALI have been proposed: antigen-antibody hypothesis versus the two-event hypothesis. Recipient factors that may be involved in the pathogenesis include the recipient’s underlying condition and genetic predisposition. Donor unit factors that may be involved in the pathogenesis include leukocyte antibody, cytokines, lipids and factor(s) that increase pulmonary endothelial cell permeability. These hypotheses and factors are discussed below.
What are the two events that are associated with trici?
The second event is transfusion of mediators, such as lipids and cytokines from stored blood products , which can prime or directly activate neutrophils, leading to pulmonary damage. These lipids include lysophosphatidylcholines, which are released from apoptotic white blood cells and platelets and have the capacity to enhance neutrophil function (32).
Does inflammation increase the risk of tali?
In both hypotheses (either direct antibody mediated activation or the two-event mechanism), it is quite likely that underlying risk factors in patients, including surgery or inflammation, enhance the risk of TRALI reactions. Inflammation has been associated with upregulation of HLA and neutrophil antigens, thus increasing the number of targets for transfused antibody and potentially increasing the probability that transfused antibodies can directly activate neutrophil function(33, 34). In addition, inflammation may upregulate vascular adhesion molecules such as P, E-selectin and ICAM-1, which in turn will facilitate accumulation of neutrophils in tissues. TRALI may occur if a second hit (ie transfusion of a lipid mediator or cytokine) enhances or directly activates neutrophil function - rapid injury of tissues, such as pulmonary parenchyma, containing the accumulated neutrophils would ensue.
Is there a test for trila?
Currently there is no definitive laboratory test for the diagnosis of TRALI. Leucopenia or neutropenia has been observed in case reports (6-12) but has not been studied in small case series (1, 13). Leukocyte antigen-antibody match between donor and recipient (HLA class I or II, granulocytes or monocytes), and neutrophil priming activity in donor blood have been reported but are not diagnostic (14)
Is transfusion of even part of one unit associated with trilli?
Transfusion of even part of one unit has been associated with TRALI
General Information
- TRALI syndrome is a transfusion-associated respiratory distress syndrome. This condition was first described in 1951. The frequency of occurrence in men and non-pregnant women is the same, it is 0.4-1.6 cases per 1,000 patients who underwent hemotransfusion. Pathology develops somewhat more often with plasma transfusion. In a number of countries, T...
Causes of Trali
- In the vast majority of cases, the etiological factor is the presence of specific antibodies in the donor’s blood that interact with HLA antigens expressed on the recipient’s leukocyte membranes. The formation of antigen-antibody complexes leads to the activation of neutrophils, triggering a cascade of pathological reactions. Another reason for the development of pathology is consider…
Pathogenesis
- Activated neutrophils begin to secrete inflammatory mediators (cytokines, interleukins, tumor necrosis factor), reactive oxygen species, proteolytic enzyme elastase. This leads to damage to the endothelial barrier of the pulmonary capillaries, an increase in vascular permeability and plasma sweating. Excessive release of nitric oxide entails pronounced vasodilation and the deve…
Classification
- According to the pathogenetic mechanism , there are 2 types of TRALI: 1. Immuno-mediated. Caused by the presence of anti-neutrophil antibodies in the components of transfused blood. 2. Non-muno-mediated. Damage to the pulmonary endothelium is caused by biologically active substances contained in long-term stored blood. According to the clinical course , the following …
Symptoms of Trali
- The clinical picture of the disease includes signs of pulmonary edema and respiratory failure. At first, breathing becomes difficult on inhalation and exhalation (shortness of breath of a mixed nature), then a cough with foamy sputum joins. As the shortness of breath worsens, the patient becomes more agitated, the heart rate and respiratory movements increase. Sometimes the bod…
Complications
- TRALI is a serious condition, poses a threat to life and requires urgent medical intervention. Without timely diagnosis and treatment, a fatal outcome occurs. The cause of death is almost always acute respiratory failure. With rapidly developing hypoxemia, the patient may lose consciousness. In patients with a subclinical course and slowly progressive respiratory dysfunct…
Diagnostics
- Usually, patients with TRALI are managed by anesthesiologists, resuscitators and transfusiologists. The crucial point in the diagnosis is the presence of a clear connection between hemotransfusion and the appearance of symptoms. To confirm the diagnosis , the following are prescribed: 1. Laboratory tests. In a general blood test in patients with immuno-mediated TRALI…
Trali Treatment
- All patients should be in the intensive care unit and intensive care unit. The first stage of treatment is the immediate cessation of blood transfusion. This measure is considered both etiotropic and pathogenetic therapy. The appointment of glucocorticosteroids is theoretically justified to suppress immunological inflammation, but there is no convincing evidence of the be…
Prognosis and Prevention
- TRALI is a severe life-threatening complication of hemotransfusion with an unfavorable prognosis. The mortality rate, according to various data, ranges from 5 to 10%. The predominant number of deaths is caused by plasma transfusion (about 50%). Prevention is of great importance, especially at the stage of harvesting donor blood. The main preventive measures ar…
Introduction
- Transfusion-related acute lung injury (TRALI) is a rare but serious syndrome characterized by sudden acute respiratory distress following transfusion. It is defined as new, acute respiratory distress during or within six hours of blood component (i.e., red blood cells, plasma, platelets) or blood product (i.e., plasma protein product) administratio...
Epidemiology
- TRALI is rare and its incidence has not been well established due to difficulty in recognizing the syndrome, inconsistent application of standard definitions, and variability in worldwide reporting mechanisms. Historically, the frequency of TRALI was estimated to occur at approximately 1 in 5,000 transfused blood components. Prospective identification of cases in an American study pl…
Clinical Presentation
- Symptoms of TRALI typically develop during or within 6 hours of a transfusion. Patients present with rapid onset of dyspnea and tachypnea, with an SpO2< 90% on room air. There may be associated fever, cyanosis and hypotension. Clinical examination may reveal hypoxic respiratory distress, and pulmonary crackles may be present without signs of congestive heart failure or vol…
Treatment and Clinical Course
- TRALI is associated with high morbidity and the majority of patients require ventilatory support. However, with supportive care, the lung injury is generally transient, with oxygen levels returning to pre-transfusion levels within 48 to 96 hours and chest X-ray returning to normal within 96 hours. However, some patients are slower to recover and may remain hypoxic with persistent pulmonar…
Differential Diagnosis
- The differential diagnosis for hypoxia after transfusion includes TRALI, TACO, cardiogenic pulmonary edema, allergic and anaphylactic transfusion reactions, transfusion-associated dyspnea (TAD), and bacteremia/sepsis due to bacterial contamination of transfused blood components. TRALI may be distinguished from TACO and cardiogenic pulmonary edema by the …
Pathophysiology
- The most widely accepted hypothesis suggests that TRALI is the result of at least two independent clinical events. The first relates to the clinical condition of the patient (e.g., active infection, history of cytokine administration, surgery, severe burn injury) that causes activation of the pulmonary endothelium. This leads to the sequestration of primed neutrophils to the activat…
Reporting Trali Events
- Health Canada mandates that hospitals identify and report adverse transfusion reactions suspected to be TRALI related. This reporting must be completed using a standard procedure for reporting adverse reactions. A guide on how to report adverse reactions and data on events reported to Canadian Blood Services are available in A Guide to Reporting Adverse Transfusion …
Prevention
- The role of health-care professionals
It is unlikely that TRALI can ever be entirely prevented, but its frequency may be reduced by the judicious use of blood components and plasma protein products only for appropriate indications. Hospitals should have procedures in place (e.g., blood utilization guidelines, blood conservation …
Further Reading
- Recent articles and reviews
1. Politis C, Wiersum JC, Richardson C, Robillard P, Jorgensen J, Renaudier P, Faber JC, Wood EM. The International Haemovigilance Network Database for the Surveillance of Adverse Reactions and Events in Donors and Recipients of Blood Components: technical issues and results. Vox Sa… - Definition/consensus articles
1. Kleinman S, Caulfield T, Chan P, Davenport R, McFarland J, McPhedran S, Meade M, Morrison D, Pinsent T, Robillard P, Slinger P. Toward an Understanding of Transfusion-Related Acute Lung Injury: Statement of a Consensus Panel. Transfusion2004; 44: 1774-89. 2. Vlaar APJ, Toy P, Fun…