Is TRALI Common After Albumin Infusion?
No, TRALI does not occur after albumin infusion—albumin is the only blood product that has never been implicated in TRALI reactions. 1
Why Albumin Does Not Cause TRALI
- All blood products except albumin have been implicated in TRALI reactions, making albumin uniquely safe from this complication 1
- Albumin is a manufactured protein product derived from pooled plasma that undergoes extensive processing, which eliminates the antibodies and cellular components responsible for TRALI 1
- Unlike fresh frozen plasma (FFP), packed red blood cells, platelets, and whole blood—which are the primary culprits in TRALI—albumin contains no donor leukocyte antibodies or HLA antibodies that trigger the reaction 1, 2
Understanding TRALI Risk with Other Blood Products
For context on what products do cause TRALI:
- TRALI is defined as noncardiogenic pulmonary edema occurring within 6 hours of transfusion of plasma-containing blood products 3, 2
- The incidence of TRALI with actual blood products is approximately 0.81 per 10,000 transfused blood components (8.1 per 100,000) 3
- FFP is temporally associated with TRALI in 86% of cases in high-risk populations 4
- In critically ill patients with end-stage liver disease and GI bleeding, TRALI incidence can reach 15-29% with plasma-containing products 4
Clinical Implications
- Albumin can be safely used without concern for TRALI in all clinical scenarios where it is indicated 1
- When volume resuscitation is needed and TRALI risk is a concern, albumin represents a safer alternative to FFP from a TRALI perspective 1
- The adverse effects associated with albumin (fluid overload, hypotension, hemodilution, anaphylaxis) do not include TRALI 3
Common Pitfall to Avoid
- Do not confuse transfusion-associated cardiac overload (TACO)—which can occur with any fluid including albumin—with TRALI, which is an immune-mediated acute lung injury that only occurs with cellular blood products and plasma 3