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Blood, 15 March 2005, Vol. 105, No. 6, pp. 2266-2273.
Prepublished online as a Blood First Edition Paper on November 30, 2004; DOI 10.1182/blood-2004-07-2929.
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Submitted July 29, 2004
Accepted November 16, 2004
Transfusion-related acute lung Injury (TRALI)
Christopher C Silliman*, Daniel R Ambruso, and Lynn K Boshkov
Department of Research, Bonfils Blood Center, Denver, Colorado, USA; Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA; Department of Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
Department of Research, Bonfils Blood Center, Denver, Colorado, USA; Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
Department of Pathology, Oregon Health and Sciences University, Portland, Oregon, USA
* Corresponding author; email: christopher.silliman{at}uchsc.edu.
Transfusion-related acute lung injury (TRALI) is a life-threatening adverse event of transfusion, which has an increasing incidence in the United States and over the past two reporting years is the leading cause of transfusion-related death. TRALI and acute lung injury (ALI) share a common clinical definition except that TRALI is temporally- and mechanistically-related to transfusion of blood/blood components. In prospective studies, two patient groups, those requiring cardiac surgery and those with hematological malignancies undergoing induction chemotherapy, were predisposed. Two different etiologies have been proposed. The first is a single antibody-mediated event involving transfusion of anti-HLA, class I and class II, or anti-granulocyte antibodies into patients whose leukocytes express the cognate antigens. The second is a two-event model: the first event is the clinical condition of the patient resulting in pulmonary endothelial activation and neutrophil sequestration, and the second event is the transfusion of a biologic response modifier (including lipids or antibodies) that activates these adherent PMNs resulting in endothelial damage, capillary leak, and TRALI. These hypotheses are discussed as are the animal models and human studies that provide the experimental and clinical relevance. Prevention, treatment, and a proposed definition of TRALI, especially in the context of ALI, are also examined.
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