A consensus redefinition of transfusion-related acute lung injury

Alexander P.J. Vlaar, Pearl Toy, Mark Fung, Mark R. Looney, Nicole P. Juffermans, Juergen Bux, Paula Bolton-Maggs, Anna L. Peters, Christopher C. Silliman, Daryl J Kor, Steve Kleinman

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and is among the leading causes of transfusion-related morbidity and mortality in most developed countries. In the past decade, the pathophysiology of this potentially life-threatening syndrome has been increasingly elucidated, large cohort studies have identified associated patient conditions and transfusion risk factors, and preventive strategies have been successfully implemented. These new insights provide a rationale for updating the 2004 consensus definition of TRALI. STUDY DESIGN AND METHODS: An international expert panel used the Delphi methodology to develop a redefinition of TRALI by modifying and updating the 2004 definition. Additionally, the panel reviewed issues related to TRALI nomenclature, patient conditions associated with acute respiratory distress syndrome (ARDS) and TRALI, TRALI pathophysiology, and standardization of reporting of TRALI cases. RESULTS: In the redefinition, the term “possible TRALI” has been dropped. The terminology of TRALI Type I (without an ARDS risk factor) and TRALI Type II (with an ARDS risk factor or with mild existing ARDS) is proposed. Cases with an ARDS risk factor that meet ARDS diagnostic criteria and where respiratory deterioration over the 12 hours before transfusion implicates the risk factor as causative should be classified as ARDS. TRALI remains a clinical diagnosis and does not require detection of cognate white blood cell antibodies. CONCLUSIONS: Clinicians should report all cases of posttransfusion pulmonary edema to the transfusion service so that further investigation can allow for classification of such cases as TRALI (Type I or Type II), ARDS, transfusion-associated circulatory overload (TACO), or TRALI or TACO cannot distinguish or an alternate diagnosis.

Original languageEnglish (US)
JournalTransfusion
DOIs
StatePublished - Jan 1 2019

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Acute Lung Injury
Adult Respiratory Distress Syndrome
Terminology
Pulmonary Edema
Developed Countries
Blood Transfusion
Leukocytes
Cohort Studies

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Vlaar, A. P. J., Toy, P., Fung, M., Looney, M. R., Juffermans, N. P., Bux, J., ... Kleinman, S. (2019). A consensus redefinition of transfusion-related acute lung injury. Transfusion. https://doi.org/10.1111/trf.15311

A consensus redefinition of transfusion-related acute lung injury. / Vlaar, Alexander P.J.; Toy, Pearl; Fung, Mark; Looney, Mark R.; Juffermans, Nicole P.; Bux, Juergen; Bolton-Maggs, Paula; Peters, Anna L.; Silliman, Christopher C.; Kor, Daryl J; Kleinman, Steve.

In: Transfusion, 01.01.2019.

Research output: Contribution to journalArticle

Vlaar, APJ, Toy, P, Fung, M, Looney, MR, Juffermans, NP, Bux, J, Bolton-Maggs, P, Peters, AL, Silliman, CC, Kor, DJ & Kleinman, S 2019, 'A consensus redefinition of transfusion-related acute lung injury', Transfusion. https://doi.org/10.1111/trf.15311
Vlaar APJ, Toy P, Fung M, Looney MR, Juffermans NP, Bux J et al. A consensus redefinition of transfusion-related acute lung injury. Transfusion. 2019 Jan 1. https://doi.org/10.1111/trf.15311
Vlaar, Alexander P.J. ; Toy, Pearl ; Fung, Mark ; Looney, Mark R. ; Juffermans, Nicole P. ; Bux, Juergen ; Bolton-Maggs, Paula ; Peters, Anna L. ; Silliman, Christopher C. ; Kor, Daryl J ; Kleinman, Steve. / A consensus redefinition of transfusion-related acute lung injury. In: Transfusion. 2019.
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AU - Bux, Juergen

AU - Bolton-Maggs, Paula

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N2 - BACKGROUND: Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and is among the leading causes of transfusion-related morbidity and mortality in most developed countries. In the past decade, the pathophysiology of this potentially life-threatening syndrome has been increasingly elucidated, large cohort studies have identified associated patient conditions and transfusion risk factors, and preventive strategies have been successfully implemented. These new insights provide a rationale for updating the 2004 consensus definition of TRALI. STUDY DESIGN AND METHODS: An international expert panel used the Delphi methodology to develop a redefinition of TRALI by modifying and updating the 2004 definition. Additionally, the panel reviewed issues related to TRALI nomenclature, patient conditions associated with acute respiratory distress syndrome (ARDS) and TRALI, TRALI pathophysiology, and standardization of reporting of TRALI cases. RESULTS: In the redefinition, the term “possible TRALI” has been dropped. The terminology of TRALI Type I (without an ARDS risk factor) and TRALI Type II (with an ARDS risk factor or with mild existing ARDS) is proposed. Cases with an ARDS risk factor that meet ARDS diagnostic criteria and where respiratory deterioration over the 12 hours before transfusion implicates the risk factor as causative should be classified as ARDS. TRALI remains a clinical diagnosis and does not require detection of cognate white blood cell antibodies. CONCLUSIONS: Clinicians should report all cases of posttransfusion pulmonary edema to the transfusion service so that further investigation can allow for classification of such cases as TRALI (Type I or Type II), ARDS, transfusion-associated circulatory overload (TACO), or TRALI or TACO cannot distinguish or an alternate diagnosis.

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