What is the treatment for Transfusion-Related Acute Lung Injury (TRALI)?

From the Guidelines

The primary treatment for Transfusion-Related Acute Lung Injury (TRALI) is supportive care, focusing on stopping the transfusion, providing oxygen therapy, and using mechanical ventilation with lung-protective strategies as needed. Management of TRALI involves immediately stopping the transfusion when suspected, and providing oxygen therapy to maintain adequate oxygenation. Many patients require mechanical ventilation with lung-protective strategies, such as tidal volumes of 6-8 mL/kg and appropriate PEEP. Hemodynamic support with intravenous fluids and vasopressors like norepinephrine may be necessary for hypotension.

Key Considerations

• Diuretics should be avoided unless there is clear volume overload, as TRALI is not a fluid overload condition, and their use may lead to increased mortality, as suggested by studies on acute kidney injury management 1.
• Corticosteroids have not shown clear benefit and are not routinely recommended for TRALI treatment.
• Monitoring for adverse events during transfusions is crucial, including clinical observations of heart rate, blood pressure, temperature, and respiratory rate, and stopping the transfusion immediately if any signs of a transfusion reaction occur 1.

Supportive Care

• Most patients recover within 48-96 hours with appropriate supportive care.
• The pathophysiology of TRALI involves neutrophil activation and pulmonary endothelial damage triggered by antibodies or biological response modifiers in transfused blood products, leading to non-cardiogenic pulmonary edema.
• Prevention strategies include using male-only plasma donors and screening for HLA antibodies in donors with a history of pregnancy.

From the Research

Treatment for TRALI

• The treatment for Transfusion-Related Acute Lung Injury (TRALI) is primarily supportive, with a focus on managing the patient's respiratory symptoms and preventing further complications 2, 3, 4, 5.
• Supportive treatment may include:
  • Oxygen therapy to help improve oxygenation and reduce hypoxia 3, 4.
  • Mechanical ventilation to support breathing and maintain adequate oxygenation 3, 6.
  • Monitoring of the patient's vital signs and respiratory status to quickly identify any changes or deterioration 3, 4.
• Diuresis is not indicated in the treatment of TRALI, as it may worsen the patient's condition 3.
• The use of steroids in the treatment of TRALI is unproven and not recommended 3.
• In severe cases of TRALI, extracorporeal membrane oxygenation (ECMO) may be used as a last resort to support the patient's respiratory function 6.

Prevention and Management

• Prevention of TRALI is important, and strategies to reduce the risk of TRALI include:
  • Using male-only plasma components to reduce the risk of anti-HLA antibodies 2, 3.
  • Implementing leucoreduction of blood components to reduce the risk of leukoagglutinating antibodies 2.
  • Using fresher blood and blood components to reduce the accumulation of biological response modifiers 2.
• When TRALI is suspected, blood banks should be notified to quarantine other components from the same donation 5.