BOF: Transfusion (Acute Transfusion Reactions)

Which of the following statements regarding transfusion-associated acute lung injury (TRALI) is true?

a) Clinical improvement usually occurs at 48-96 hours following the acute event

b) 50% of cases are fatal

c) It is defined as an acute dyspnoea with hypoxia and bilateral pulmonary infiltrates presenting within 24 hours of transfusion

d) Leucocyte antibodies from donors are implicated in 50% of cases

e) The highest risk occurs with red cell transfusions

Answer:

a) Clinical improvement usually occurs at 48-96 hours following the acute event

Explanation:

TRALI is defined as acute dyspnoea with hypoxia and bilateral pulmonary infiltrates within 6 hours of transfusion not due to circulatory overload or other causes. 5-10% of cases are fatal. Treatment is supportive with clinical improvement usually occurring at 48-96 hours following the acute event. Risk is greatest with plasma products and platelets and leucocyte antibodies from donors are implicated in 90% of cases. This has led to the exclusion of female donations for plasma products and previously platelets due to the increased risk of their having pregnancy-sensitised HLA antibodies.

Reference:

Storch EK, Hillyer CD, BH Shaz. Spotlight on pathogenesis of TRALI: HNA-3a (CTL2) antibodies. Blood Sep 2014, 124 (12) 1868-1872