Treatment of Transfusion-Associated Lung Injury (TRALI)
Immediately stop the transfusion and provide supplemental oxygen as the cornerstone of treatment; avoid diuretics, which are ineffective and may worsen the condition by causing hypovolemia. 1, 2
Immediate Actions
Stop the transfusion immediately upon suspicion of TRALI and maintain intravenous access with normal saline for medication administration and potential fluid resuscitation. 1, 2 This is the single most critical intervention that can prevent progression to severe morbidity or mortality. 3
Notify the blood bank immediately, as TRALI is underdiagnosed and underreported despite being a leading cause of transfusion-related mortality. 1, 2 This notification is crucial for both patient safety and donor investigation. 1
Respiratory Support
Provide supplemental oxygen as the primary therapeutic intervention. 1, 4 In mild cases, nasal oxygen administration may be sufficient. 4
For severe cases requiring mechanical ventilation, utilize lung-protective strategies including:
- Low tidal volumes 1
- Positive end-expiratory pressure (PEEP) 1
- Monitor peak airway pressures continuously 1, 2
With appropriate respiratory intervention, approximately 80% of patients recover within 96 hours of the original insult, with no permanent pulmonary sequelae. 5
Fluid Management
Avoid diuretics entirely - they are ineffective for TRALI and contraindicated because they may worsen the condition by causing hypovolemia. 1, 2, 4 This is a critical distinction from transfusion-associated circulatory overload (TACO), where diuretics are indicated. 3
Maintain conservative fluid practices, avoiding both hypotension and overhydration. 1 In severe cases requiring invasive hemodynamic monitoring, careful fluid management is essential. 4
Supportive Care
Provide critical care supportive measures focusing on maintaining adequate oxygenation and hemodynamic stability. 2, 6 Treatment is primarily supportive, with a prognosis substantially better than most other causes of acute lung injury. 6
Monitor vital signs closely, including respiratory rate, pulse, blood pressure, temperature, and oxygen saturation. 2, 3
Controversial Therapies
Glucocorticoid administration remains controversial with no clear evidence supporting routine use. 4 The evidence does not support their routine administration in TRALI management.
Diagnostic Considerations
TRALI presents with acute respiratory distress, hypoxemia, dyspnea, and bilateral pulmonary infiltrates within 6 hours of transfusion (typically 1-2 hours). 1, 4, 6 The key distinguishing feature is non-cardiogenic pulmonary edema without evidence of circulatory overload. 1, 2
Common pitfall: Distinguishing TRALI from TACO is critical, as their treatments differ fundamentally - TACO requires diuretics while TRALI requires avoiding them. 1, 3 Look for absence of cardiovascular changes and fluid overload signs to differentiate TRALI from TACO. 2