Transfusion-Related Acute Lung Injury (TRALI) is the leading cause of transfusion-related mortality in most developed countries.
Despite this fact, well-designed investigations on specific management strategies for TRALI are lacking. Indeed, current recommendations
are primarily based on data extrapolated from trials of the histo-pathologically similar Acute Lung Injury and Acute Respiratory
Distress Syndromes. The cornerstone of TRALI management is supportive care with oxygen supplementation and ventilatory assistance
when needed. When mechanical ventilation is required, attenuating additional ventilator-induced lung injury through the avoidance
of high tidal volumes and elevated airway pressures, with additional measures such as positive end-expiratory pressure to prevent lowvolume
shear stress injury, are recommended. The literature is not currently sufficient to support either corticosteroids or statins as effective
therapies in TRALI. Conservative fluid practices are desirable, provided care is taken to avoid hypotension. Preventative strategies
have shown the most promise in mitigating this transfusion-related pulmonary complication. Specifically, conservative transfusion practices
and deferral of high-plasma component donors who have, or at high risk of having, anti-human leukocyte antigen and/or anti-human
neutrophil antigen antibodies have meaningfully impacted the incidence of TRALI. Future considerations for patients who are at increased
risk for developing TRALI may include therapies such as anti-platelet agents and alternatives to traditional blood components
such as prothrombin complex concentrates (PCC). However, these potential TRALI prevention strategies are insufficiently studied, have
unclear risk/benefit profiles and cannot be currently recommended.
Keywords: Acute lung injury/therapy, acute lung injury/diagnosis, acute lung injury/prevention & control, erythrocyte transfusion/adverse effects, HLA antigens/adverse effects, humans, platelet transfusion/adverse effects, respiratory distress syndrome, adult/therapy, Transfusion-Related Acute Lung Injury (TRALI)
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