State of the art management of transfusion-related acute lung injury (TRALI)

Andrew D. Goldberg, Daryl J Kor

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Transfusion-Related Acute Lung Injury (TRALI) is the leading cause of transfusion-related mortality in most developed countries. Despite this fact, well-designed investigations on specific management strategies for TRALI are lacking. Indeed, current recommendations are primarily based on data extrapolated from trials of the histo-pathologically similar Acute Lung Injury and Acute Respiratory Distress Syndromes. The cornerstone of TRALI management is supportive care with oxygen supplementation and ventilatory assistance when needed. When mechanical ventilation is required, attenuating additional ventilator-induced lung injury through the avoidance of high tidal volumes and elevated airway pressures, with additional measures such as positive end-expiratory pressure to prevent lowvolume shear stress injury, are recommended. The literature is not currently sufficient to support either corticosteroids or statins as effective therapies in TRALI. Conservative fluid practices are desirable, provided care is taken to avoid hypotension. Preventative strategies have shown the most promise in mitigating this transfusion-related pulmonary complication. Specifically, conservative transfusion practices and deferral of high-plasma component donors who have, or at high risk of having, anti-human leukocyte antigen and/or anti-human neutrophil antigen antibodies have meaningfully impacted the incidence of TRALI. Future considerations for patients who are at increased risk for developing TRALI may include therapies such as anti-platelet agents and alternatives to traditional blood components such as prothrombin complex concentrates (PCC). However, these potential TRALI prevention strategies are insufficiently studied, have unclear risk/benefit profiles and cannot be currently recommended.

Original languageEnglish (US)
Pages (from-to)3273-3284
Number of pages12
JournalCurrent Pharmaceutical Design
Volume18
Issue number22
StatePublished - Jul 2012

Fingerprint

Acute Lung Injury
Ventilator-Induced Lung Injury
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Positive-Pressure Respiration
Tidal Volume
Adult Respiratory Distress Syndrome
HLA Antigens
Artificial Respiration
Developed Countries
Hypotension
Adrenal Cortex Hormones
Neutrophils
Blood Platelets
Tissue Donors
Oxygen
Antigens
Pressure
Lung
Mortality
Antibodies

Keywords

  • Acute lung injury/diagnosis
  • Acute lung injury/prevention & Control
  • Acute lung injury/therapy
  • Adult/therapy
  • Erythrocyte transfusion/adverse effects
  • HLA antigens/adverse effects
  • Humans
  • Platelet transfusion/adverse effects
  • Respiratory distress syndrome

ASJC Scopus subject areas

  • Drug Discovery
  • Pharmacology

Cite this

State of the art management of transfusion-related acute lung injury (TRALI). / Goldberg, Andrew D.; Kor, Daryl J.

In: Current Pharmaceutical Design, Vol. 18, No. 22, 07.2012, p. 3273-3284.

Research output: Contribution to journalArticle

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