There are no conclusive tests to diagnose transfusion-related acute lung injury (TRALI). The condition should be suspected if the clinical picture corresponds with TRALI clinical findings, such as hypoxemia within 6 hours of transfusion. The clinical findings should correlate with chest radiograph findings of bilateral infiltrates. It is important to rule out cardiac causes of pulmonary edema. One way of differentiating is evaluating the B-type natriuretic peptide (BNP) level, which is known to be elevated in congestive heart failure and not TRALI; however, the level would depend on the patient's underlying condition and whether or not they had an elevated BNP before the transfusion. Ideally, the current BNP value would be compared to a pre-transfusion baseline value.
In the majority of cases, the donor plasma will demonstrate anti-HLA antibodies.
Urgent treatment consists of respiratory and volume support. Patients usually require supplemental oxygen, some by a mechanical ventilator. Vasopressor medications can be used to treat hypotension. Extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass have successfully treated TRALI when conventional methods do not work. Diuretics are contraindicated in TRALI.
Patients with TRALI usually improve within 48 to 96 hours. TRALI is fatal in about 5% to 10% of cases.
