Diagnosis of Transfusion-Related Acute Lung Injury (TRALI) in a Heart Failure Patient / 대한수혈학회지

ABSTRACT

A 71-yr old man with known coronary heart disease complained of dyspnea and severe sweating one hour after transfusion of one unit of packed Red Blood Cells (pRBC). Although the heart failure was secondary to the remote acute myocardial infarction, except inflammatory lesion in his toes, he had remained asymptomatic for a long time. Observed as having clear lungs a few hours before transfusion, the patient suffered an acute hypoxic episode (SpO2=61%) and a resulting chest x-ray revealed bilateral pulmonary infiltrates. Confused as the cause of the acute deterioration, he was transferred to the intensive care unit and received managed lung care by mechanical ventilation as well as other conservative care methods. Two days after the acute hypoxic event there was apparent clinical improvement, and he was weaned from ventilator support. His amelioration resulted in subsequent diagnosis of Transfusion-Related Acute Lung Injury (TRALI). TRALI is underdiagnosed in patients due to its nebulous nature. Evaluating patients exhibiting symptoms of bilateral lung infiltrate after blood transfusion for TRALI, and subsequent reporting of the diagnosis results, will help reveal the actual frequency of incidence of TRALI, and prevent additional events by tracing the blood donor.