Transfusion-Related Acute Lung Injury (TRALI): A Retrospective Analysis of 119 Cases.

Abstract Following Institutional Review Board approval, detailed data involving patient, product, and clinical factors was retrospectively gathered on 119 TRALI cases identified between 1991 and 1998 at University of Alberta Hospital in Edmonton, AB. This data was gathered as a complement to previously published work (Silliman et al, Blood2003: 101: 454) on the epidemiology and etiology of TRALI which consisted of 90 sequentially-identified TRALI reactions in 81 patients. In the current study we sought additional detailed clinical and laboratory data on these cases and others identified during the stated time period. Our aim was to help characterize patients who get TRALIs and/or to identify clinical correlates of TRALI. All TRALI were identified on the basis of 1) acute onset of respiratory distress mandating urgent medical intervention as the predominant symptom (peripheral or central cyanosis was noted in virtually all cases and all required supplemental oxygen.); 2)symptoms temporally associated with transfusion of a blood product, and 3) no other cause for the acute respiratory deterioration evident. All diagnoses were reviewed by a transfusion medicine physician. Data was abstracted onto prepared questionnaire forms by 2 of us (LKB and LP) following detailed review of hospital charts and transfusion service records. An electronic database was then prepared using deidentified forms (unique patient code substituted for name and date of birth) and data entered by double entry to assure accuracy. Not all data fields were available on all patients. Preliminary data analysis of these TRALI cases reveals: Mean age of TRALI patients: 39.07 years (range 3 mos – 91 years). Gender: 49% male, 51 % female Hypoxemia: Arterial blood gases available on 41 cases. All hypoxemic on basis of O2 saturation < 90% on room air or higher FIO2. Diagnosis of malignancy: 77 / 119 = 65 % of which 54 (45%) were on chemotherapy. Most of the malignancies were hematological. Cardiopulmonary bypass: 13 patients: 9 coronary artery bypass grafts (one with valve replacement), 3 valve replacements and one ventricular septal defect closure Surgery: 58 cases with preceding surgery within 1–2 days of TRALI (17 central venous cather insertions, 4 endoscopy or bronchoscopy and 37 other major or minor surgery) Time from initiation of transfusion to onset of symptoms: < 15 mins (n=15), 15 min – 1 hr (n=56), 1–2 hrs (n=14), unknown (n = 34) Type of venous access used for transfusion: central line (n = 24), peripheral line (n=7), unknown (n=63) Pre-transfusion white blood cell (WBC) count x 10-9/L: Available in 107 cases.. Average = 13.8 (range 0.1 – 259). WBC > 30: n = 8; WBC < 1.5: n = 40; WBC 1.1–1.5: n = 3; WBC 0.6–1.0: n = 9; WBC 0.3–0.5: n = 21; WBC 0.2: n = 4; WBC 0.1: n=3. Although these data are retrospective and limited, they suggest that TRALI can be seen in any age group, is equally common in males and females, is most often rapid in onset (15 min – 1 hour), and can occur even at low WBCs. Although it is unclear from the present data alone, an increased frequency of TRALI was noted in a nested case-control study (see reference above) in patients with underlying hematological malignancy and antecedent cardiopulmonary bypass.

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