TRALI - Definition

Transfusion-related acute lung injury (TRALI)

An international consensus conference on TRALI held in Canada in 2004 advised that TRALI should be recognized as a clinical syndrome and not as a disease with a single etiology.

Definition:

The Canadian consensus conference defined TRALI as having the following criteria:

(a) acute onset,

(b) hypoxemia as defined by a PaO2/FiO2 ≤300 or oxygen saturation by pulse oximetry less than 90% on room air,

(c) bilateral lung infiltrates on chest X ray,

(d) no evidence of left atrial hypertension,

(e) occurrence during or within 6 hours of transfusion, and

(f) no preexisting ALI before transfusion or temporal relationship to an alternative ALI risk factor .

Possible TRALI:

In cases of TRALI occurring in the setting of transfusion and an alternative risk factor for ALI, a designation of “possible TRALI” was added. These alternative risk factors included a variety of conditions that may directly or indirectly induce lung injury, such as pneumonia, pulmonary contusion, and sepsis.

Limitations of the definition:

(1) This definition, however, does not acknowledge the effects of positive end expiratory pressure on the PaO2/FiO2 ratio.

(2) An additional important limitation of this definition is that it excludes patients with preexisting ALI, whose lung injury worsens after transfusion.

Ref: Journal of Intensive Care Medicine / Vol. 23, No. 2, March/April 2008

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