TRALI

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  • In 2019, a modified classification scheme was proposed based on new knowledge gained since the 2004 CCC (Canadian Consensus Conference). This classification, which was developed by a Delphi panel composed of international TRALI experts, reaffirmed that TRALI remains a clinical diagnosis and does not require detection of cognate leukocyte antibodies.

  • What is TRALI 1 ?

       No risk factors for ARDS and all the following criteria are met 
      1. Acute onset
      2. Hypoxemia (PaO2/FiO2 ≤300 mmHg or SpO2 <90% on room air)
      3. Clear evidence of bilateral pulmonary edema on imaging
      4. No evidence of LAHΔ or, if LAH is present, it is judged to not be the main contributor to the hypoxemia
  2. Onset during or within 6 hours of transfusion◊
  3. No temporal relationship to an alternative risk factor for ARDS.


  • What is TRALI 2?

       Risk factors for ARDS are present (but ARDS has not been diagnosed) or mild ARDS at  baseline* but with respiratory            status deterioration that is judged to be due to  transfusion based on both of the following:

       Findings as described in categories a and b of TRALI type I

       Stable respiratory status in the 12 hours before transfusion.



  • What is TAD (Transfusion associated dyspnea)?

           Used when pulmonary edema occurs greater than 6 hours after the transfusion and is clinically suspicious for         temporal association with transfusion.


  •  How do we treat TRALI?

    • Discontinuing of blood product.
    • Supportive therapy with oxygen and if required ventilation with lung protective strategy
    • Steroids are not recommended.
        

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