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Transfusion Related Acute Lung Injury

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Transfusion related acute lung injury (TRALI) has been an upcoming cause of transfusion related mortality. It is characterized by the sudden development of non cardiac related pulmonary edema after transfusion of blood products. According to the Food and Drug Administration (FDA), in the past two reporting years, it has been the leading cause of transfusion related deaths. It is of severe importance for physicians, nurses and also laboratory scientists to become familiar with the presentations of TRALI since many cases will remain unnoticed or will be misdiagnosed as fluid overload, or acute lung injury of other etiology. In order to properly diagnose a patient with TRALI, there are several criteria that needs to be followed. There needs…show more content…
Intravenous immunoglobulin (IVIG) has the capacity to cause TRALI if it contains a significant amount of anti-leukocyte antibodies directed against antigens on the recipient’s leukocytes. Reactions triggered by IVIG are much more rare than the ones triggered by plasma containing blood products. As with any transfusion reaction, it is imperative to comprehend the pathophysiology of this condition. There are two main mechanisms as to why TRALI can occur. There is an immune and a non immune mechanism of action. The immune mechanism is antibody mediated. It is believed that ninety percent of the time the antibodies originate in the donor blood product, and ten percent of the time the antibodies originate in the recipient. The antibodies are against HLA I, HLA II or HNA. Leukocyte antibodies can activate neutrophils directly, through anti HLA class I or anti HNA, or neutrophils can be activated indirectly by anti HLA class II . After being activated, either directly or indirectly, neutrophils release a neutrophil activating substance. Once other neutrophils are activated the produce reactive oxygen substances and release enzymes, such as elastase. Elastase causes the endothelium to become more permeable for plasma constituents, ultimately leading to pulmonary edema. The non immune mechanism relies on the patient’s pre existing condition as an underlying factor in the onset of TRALI. There
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