Transfusion-related acute lung injury (TRALI) should be considered whenever a transfusion recipient experiences acute respiratory insufficiency or x-ray films show findings consistent with pulmonary edema without evidence of cardiac failure. These are possibly reactions between the donor’s leukocyte antibodies and the recipient’s leukocytes. TRALI produces white cell aggregates that become trapped in the pulmonary microcirculation. The findings on chest x-ray films are typical of acute pulmonary edema and the condition is life-threatening.

The diagnosis of TRALI includes the following:

• Acute onset of respiratory distress

• Hypoxemia

• Bilateral lung infiltration on x-ray

• No evidence of circulatory overload