Blood Reviews
Volume 23, Issue 6 , Pages 245-255, November 2009

Transfusion-related acute lung injury (TRALI): Current concepts and misconceptions

  • Christopher C. Silliman

      Affiliations

    • Bonfils Blood Center, Denver CO, USA
    • The Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
    • Surgery, University of Colorado Denver, Aurora, CO, USA
    • Corresponding Author InformationCorresponding author. Address: Research Department, Bonfils Blood Center, 717 Yosemite Street, Denver, CO 80230, USA. Tel.: +1 303 363 2246; fax: +1 303 340 2616.
    • ,
  • Yoke Lin Fung

      Affiliations

    • Australian Red Cross Blood Service, Brisbane, Queensland, Australia
    • ,
  • J. Bradley Ball

      Affiliations

    • Bonfils Blood Center, Denver CO, USA
    • The Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
    • ,
  • Samina Y. Khan

      Affiliations

    • Bonfils Blood Center, Denver CO, USA
    • The Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA

published online 21 August 2009.

Summary 

Transfusion-related acute lung injury (TRALI) is the most common cause of serious morbidity and mortality due to hemotherapy. Although the pathogenesis has been related to the infusion of donor antibodies into the recipient, antibody negative TRALI has been reported. Changes in transfusion practices, especially the use of male-only plasma, have decreased the number of antibody-mediated cases and deaths; however, TRALI still occurs. The neutrophil appears to be the effector cell in TRALI and the pathophysiology is centered on neutrophil-mediated endothelial cell cytotoxicity resulting in capillary leak and ALI. This review will detail the pathophysiology of TRALI including recent pre-clinical data, provide insight into newer areas of research, and critically assess current practices to decrease it prevalence and to make transfusion safer.

Keywords: Neutrophils, Priming, Two event model, Antibodies, Lipids

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PII: S0268-960X(09)00044-7

doi:10.1016/j.blre.2009.07.005

Blood Reviews
Volume 23, Issue 6 , Pages 245-255, November 2009

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