Transfusion-related acute lung injury

Background

• Respiratory syndrome with hypoxia and bilateral CXR infiltrates associated with blood transfusion
  • Mostly with RBCs, platelets, or plasma, but can rarely happen after cryoprecipitate or IVIg
• Occurs within 6 hours of transfusion, with no evidence of heart failure
• Occurs in about 1 in 10,000 transfusion
• Mortality is 5 to 10%
• Unclear pathophysiology

Clinical Manifestations

• Onset usually within 1 to 2 hours of transfusion, but may be up to 6 hours
• Dyspnea and hypoxia
• Bilateral infiltrates on chest x-ray
• Presents similarly to ARDS
• Usually resolves within 24 to 72 hours

Management

• Stop transfusion
• Supportive care; often requires mechanical ventilation
• Diuretics and steroids not helpful