Transfusion Related Acute Lung Injury: A comprehensive review with a focus on the critically ill

Abulhassan Ali, Faris Abu Za’nouneh, Collin Clarke, Shunsuke Kondo, Christian John S Capirig, Ehab G Daoud

Abstract

Transfusion-related acute lung injury (TRALI) is a severe, life-threatening complication of blood products transfusion characterized by acute hypoxemia and non-cardiogenic pulmonary edema, typically within six hours following transfusion of blood products. It is a highly morbid complication in critically ill patients, particularly those with pre-existing lung injury or systemic inflammation. TRALI remains frequently under-reported due to diagnostic challenges, mainly attributable to the absence of validated confirmatory tests, resulting in diagnostic uncertainty, delayed recognition, and unfavorable clinical outcomes.

The present review represents an extensive literature search for evidence related to the diagnostic utility of novel biomarkers, including interleukin-8, soluble intracellular adhesion molecules, and a review of existing data on management strategies in the critical care setting, including the role of mechanical ventilation, non-invasive ventilation, and the potential roles of immunomodulatory therapies. Through a focused lens on critically ill populations, this review aims to clarify the current TRALI diagnosis and management landscape while highlighting areas for ongoing investigation.

Keywords:  Transfusion-related acute lung injury (TRALI), biomarker, mechanical ventilation, critically ill

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