A 52-year-old woman with a history of DVT on warfarin and active smoker develops several days of epigastric pain and melena and presents to the ED with a hemoglobin of 5.5 and tachycardia without hypotension, INR of 3.9, and a platelet count of 215,000/ µL. Following transfusion of 2 units PRBCs and 2 units FFP, she develops rapidly progressive acute hypoxemic respiratory failure and increased work of breathing requiring intubation, with CXR new confirming bilateral infiltrates.
Which of the following statements is true of the most likely etiology for her respiratory decompensation?
A. Risk factors include smoking and chronic alcohol useCorrect Answer: C
TRALI is defined as new ARDS occurring within 6 hours of blood product administration, and in the absence of other risk factors for ARDS (such as aspiration, trauma, pneumonia). The incidence of TRALI declined dramatically in the last decade following a reduction in the use of plasma from multiparous female donors (which includes anti-HLA antibodies proportional to the number of pregnancies). Recipient risk factors include alcohol abuse, shock, and smoking. Although TRALI can occur after the transfusion of any blood product, high plasma components such as plasma, apheresis platelets, and whole blood have the highest risk per transfusion. TRALI most often occurs when passively transferred HLA and human neutrophil antigen antibodies activate neutrophils that have been sequestered in the lung microvasculature.
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