Pathology consultation on transfusion-related acute lung injury (TRALI)

Am J Clin Pathol. 2012 Oct;138(4):498-503. doi: 10.1309/AJCPFF6JKXM7BYOI.


Transfusion-related acute lung injury (TRALI) is a serious condition characterized by respiratory distress, hypoxia, and bilateral pulmonary infiltrates, which occur within 6 hours of transfusion. Several theories have been proposed to explain the underlying pathologic mechanisms of TRALI. Immune-mediated TRALI accounts for over 80% of reported cases and is mediated by donor antibodies to HLAs and/or human neutrophil antigens (HNA). Immune-mediated TRALI is most commonly associated with donor plasma transfusion or other blood products from multiparous women, which has led many countries to reduce or exclude women from donating high-volume plasma products. This policy change has resulted in a decrease in the incidence of TRALI and highlighted the importance of nonimmune-mediated TRALI, which is thought to be caused by bioreactive lipids and other biologic response modifiers that accumulate during storage of blood products. When TRALI is suspected, clinical consultation with a transfusion medicine specialist helps differentiate it from other transfusion reactions with similar characteristics.

MeSH terms

  • Acute Lung Injury / diagnosis*
  • Acute Lung Injury / etiology*
  • Acute Lung Injury / immunology
  • Adult
  • Blood Donors
  • Donor Selection
  • Female
  • Humans
  • Hypoxia / etiology
  • Hypoxia / immunology
  • Hypoxia / pathology
  • Male
  • Parity / immunology
  • Pathology*
  • Pulmonary Edema / etiology
  • Pulmonary Edema / immunology
  • Pulmonary Edema / pathology
  • Referral and Consultation*
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / immunology
  • Respiratory Distress Syndrome / pathology
  • Transfusion Reaction*