Quick Notes on TRALI

Rare (0.04 to 0.1% of transfused patients) but fatal complication of transfusion

Plasma components and platelet concentrates historically highest risk, however mitigation strategies have reduced this. Now largest # TRALI deaths from PRBCs, see chart:

FY09:FFP:2;RBC:6;FP24:1;Platelets Pheresis:2;Pooled Platelets:0;Multiple Products:2
FDA: Incidence of TRALI Mortality

Risks

blood component
-plamsa / whole blood from Females
– increased HLA Class II ab with specificity for HLA antigen
-increased anti-HNA Ab
-NOT RBC storage duration

Patient
-liver transplant surgery
-chronic alcohol abuse
-shock
-high peak airway pressures during ventilation
-smokers
-high IL-8 levels
-positive fluid balance

References:

UpToDate: TRALI (last update July 2015)

http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/ucm391574.htm

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