The pathophysiology and prevention of transfusion-related acute lung injury (TRALI): a review

Transfusion-related acute lung injury (TRALI) is a clinically important complication of transfusion that is often difficult to diagnose, is probably underreported, and likely has a multifactorial origin that is incompletely understood, making it challenging to find effective treatments and preventative steps. The spectrum of its severity and clinical symptoms seems wide, but its pathogenesis is most likely associated with pulmonary damage from activated recipient neutrophils. Despite the pathogenesis of TRALI being unclear, many severe cases are related to transfusion of donor WBC antibodies, and preventive measures based on avoiding donations by multiparous donors have been implemented at some sites, with early reports showing benefits. This review will address some of the questions surrounding the etiology of this potentially fatal reaction and how measures, predicated on many severe cases being related to transfusion of plasma from multiparous donors, led to preventive steps to avoid these donations. Immunohematology2010;26:161–73.