Transfusion-associated acute lung injury (TRALI) is a complication of blood transfusion that results in shortness of breath due to pulmonary edema, fever, and hypotension. The pulmonary edema is noncardiogenic, which means it does not originate from the heart. TRALI is a severely life-threatening adverse reaction. Symptoms manifest within 6 hours of transfusion.
Products typically implicated in TRALI are Whole Blood, Red Blood Cells, Fresh Frozen Plasma, Cryoprecipitate, and Platelets. A higher proportion of these reactions with plasma and platelet units from multiparous women donors. Consequently, donor centers now prepare plasma from male donors or from female donors who have been tested for HLA antibodies.
The AABB Blood Bank and Transfusion Service Program addresses TRALI mitigation in its standard 5.4.1.3, which reads:
"Plasma, Apheresis Platelets, and Whole Blood for allogeneic transfusion shall be from donors who have not been pregnant, or who have been tested since their most recent pregnancy and results interpreted as negative for HLA antibodies."
*Reference: Standards for Blood Banks and Transfusion Services. 34th ed. AABB; 2024.
