Transfusion-Related Acute Lung Injury

A rare but serious transfusion-related reaction in which fluid builds up in the lungs unrelated to excessively high infusion rate and/or volume (TRANSFUSION-ASSOCIATED CIRCULATORY OVERLOAD). Signs of Transfusion-Related Acute Lung Injury include pulmonary secretions; hypotension; fever; DYSPNEA; TACHYPNEA; TACHYCARDIA; and CYANOSIS.

Also Known As:

Networked: 681 relevant articles (17 outcomes, 45 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Transfusion-Related Acute Lung Injury
2.	Lung Injury
3.	Transfusion Reaction
4.	Inflammation (Inflammations)
5.	Edema (Dropsy)

Experts

1.	Silliman, Christopher C: 22 articles (01/2019 - 12/2002)
2.	Looney, Mark R: 20 articles (11/2020 - 07/2004)
3.	Semple, John W: 19 articles (01/2021 - 10/2010)
4.	Vlaar, Alexander P J: 17 articles (01/2022 - 02/2010)
5.	Juffermans, Nicole P: 17 articles (12/2020 - 02/2010)
6.	Toy, Pearl: 16 articles (11/2020 - 12/2004)
7.	Porcelijn, Leendert: 15 articles (11/2020 - 01/2010)
8.	Reil, Angelika: 15 articles (10/2020 - 08/2005)
9.	Kapur, Rick: 14 articles (11/2020 - 12/2015)
10.	Bux, Jürgen: 13 articles (01/2019 - 06/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Transfusion-Related Acute Lung Injury:

1.	AntibodiesIBA 01/01/2011 - "There is accumulating evidence that preventive measures such as transfusion of plasma-rich blood components from male donors or from donors tested negative for leucocyte antibodies are effective in the reduction of severe and fatal immune TRALI." 02/03/2011 - "Fourth, back to the bedside, policy changes based on results of these studies, such as minimizing use of plasma and platelet products from donors with leukocyte antibodies, have decreased the incidence of TRALI. " 12/01/2015 - "In this study, we found alloimmunization against HLA class I, II and HNA in 4.63, 24.70 and 0.39%, respectively, in our female blood donors, indicating that the use of plasma containing blood products from parous female blood donors without HLA antibodies pre-testing may increase the risk of TRALI reaction. " 10/01/2012 - "Although the pathogenesis of TRALI is incompletely understood, substantial data from hemovigilance systems, large case series, clinical trials, and animal models have identified antileukocyte antibodies as a major precipitant and have contributed to the development of concrete interventions to reduce the risk of TRALI. " 05/01/2012 - "Studies have shown that the transfusion of HLA and HNA antibodies in donor plasma can lead to TRALI. "
2.	CytokinesIBA 01/01/2020 - "This study investigated whether IL-35, an endothelial stabilizing cytokine could regulate the severity of antibody-mediated TRALI in vivo. " 01/01/2022 - "Early clinical monitoring of changes in Treg-related cytokine levels can provide some guidance for prognostic assessment of TRALI patients." 08/01/2015 - "A predictive model incorporating readily available clinical and cytokine data effectively differentiated transfusion-related respiratory complications such as TRALI and TACO." 02/01/2003 - "Activation of monocytes and their subsequent release of cytokines may play a role in the pathogenesis of TRALI." 07/01/2014 - "In a murine model of TRALI, C1-inhibitor attenuated pulmonary levels of C3a associated with improved lung injury scores, but with persistent high levels of inflammatory cytokines."
3.	Adrenal Cortex Hormones (Corticosteroids)IBA 04/01/2014 - "Anecdotally, TRALI patients have been treated with corticosteroids. " 09/01/2009 - "TRALI improved with non-invasive ventilation support and use of high dose corticosteroids." 04/01/2014 - "We determined the effects of corticosteroids on lung injury in a "two-hit" mouse model of antibody-mediated TRALI. " 11/01/2020 - "She could not tolerate plasmapheresis due to transfusion-related acute lung injury but responded well to corticosteroids and discontinuation of nivolumab. " 01/01/2012 - "The literature is not currently sufficient to support either corticosteroids or statins as effective therapies in TRALI. "
4.	AntigensIBA 11/01/2009 - "Previously, we established an immune-mediated TRALI mouse model, wherein mice with cognate antigen were challenged with MHC class I mAb. In this study, when mice housed in a rodent, specific pathogen-free barrier room were challenged with MHC I mAb, there was significant protection from TRALI compared with nonbarrier mice. " 10/01/2008 - "The significance of multiple HLA antigen/antibody matching between donor and recipient in immune TRALI warrants further study." 11/01/2022 - "HNA-3 genotype and HNA-3a antigen expression impacted the severity of anti-HNA-3a-mediated HLMVEC cytotoxicity in a two-hit neutrophil-dependent model of TRALI. " 11/01/2022 - "Human neutrophil antigen 3 genotype impacts neutrophil-mediated endothelial cell cytotoxicity in a two-event model of TRALI." 10/26/2021 - "In conclusion, we introduce a new TRALI mechanism based on the specific binding of transfused, soluble antigens to activated ECs in preimmunized recipients. "
5.	SolventsIBA 01/01/2022 - "Incidence of transfusion-related acute lung injury temporally associated with solvent/detergent plasma use in the ICU: A retrospective before and after implementation study." 01/01/2022 - "Reported transfusion-related acute lung injury associated with solvent/detergent plasma - A case series." 06/01/2018 - "Anesthesiologists can play a role in decreasing these risks by increasing recognition and reporting of TRALI and TACO, using point of care testing with thromboelastography to guide and decrease transfusion, and considering alternatives to traditional blood products like solvent/detergent plasma." 05/01/2009 - "In no case, pooled fresh frozen plasma (100 donations) treated with solvent-detergent were involved in French TRALI cases. " 01/01/2022 - "Transfusion-related acute lung injury (TRALI) is a severe complication of plasma transfusion, though the use of solvent/detergent pooled plasma (SDP) has nearly eliminated reported TRALI cases. "
6.	Detergents (Detergent)IBA 01/01/2022 - "Incidence of transfusion-related acute lung injury temporally associated with solvent/detergent plasma use in the ICU: A retrospective before and after implementation study." 01/01/2022 - "Reported transfusion-related acute lung injury associated with solvent/detergent plasma - A case series." 06/01/2018 - "Anesthesiologists can play a role in decreasing these risks by increasing recognition and reporting of TRALI and TACO, using point of care testing with thromboelastography to guide and decrease transfusion, and considering alternatives to traditional blood products like solvent/detergent plasma." 05/01/2009 - "In no case, pooled fresh frozen plasma (100 donations) treated with solvent-detergent were involved in French TRALI cases. " 01/01/2022 - "Transfusion-related acute lung injury (TRALI) is a severe complication of plasma transfusion, though the use of solvent/detergent pooled plasma (SDP) has nearly eliminated reported TRALI cases. "
7.	Tirofiban (Aggrastat)FDA Link 01/01/2023 - "PLATELET SUPPRESSION BY TIROFIBAN AMELIORATES PULMONARY COAGULATION AND FIBRINOLYSIS ABNORMALITIES IN THE LUNGS OF MOUSE ANTIBODY-MEDIATED TRANSFUSION-RELATED ACUTE LUNG INJURY." 01/01/2023 - "In this study, wild-type male Balb/c mice aged 8 to 10 weeks were randomly divided into the TRALI model, blank control, tirofiban intervention, and isotype control groups. " 01/01/2023 - "In conclusion, our findings suggest that tirofiban might interfere with TRALI by inhibiting platelet activation and improving coagulation and fibrinolytic abnormalities." 01/01/2023 - "Compared with the TRALI model group, the lung injury indices in the tirofiban intervention group decreased significantly, and survival rates also improved. " 01/01/2023 - "Furthermore, the coagulation, anticoagulation, and fibrinolysis assays were measured by automatic coagulation instrument and enzyme-linked immunosorbent assay kits, and the fluorescence densities of platelets and fibrin were quantified using immunofluorescence to analyze the effects of tirofiban on the platelet and fibrin interactions of TRALI. "
8.	Aspirin (Acetylsalicylic Acid)FDA LinkGeneric 06/01/2012 - "Aspirin has been found to improve outcomes in an animal model of transfusion-related acute lung injury. " 06/01/2012 - "Use of aspirin did not alter the risk of transfusion-related acute lung injury after transfusion of platelets (OR 1.06, CI 0.59-1.91, p = 0.85), plasma (OR 1.06, 95% CI 0.59-1.92, p = 0.84), or red blood cells (OR 1.09, 95% CI 0.61-1.94, p = 0.77). " 11/01/2009 - "Platelet depletion and aspirin treatment protect mice in a two-event model of transfusion-related acute lung injury." 06/01/2012 - "We examined the association of aspirin use before admission to the intensive care unit and the development of transfusion-related acute lung injury in critically ill patients. " 06/01/2012 - "The effect of aspirin in transfusion-related acute lung injury in critically ill patients."
9.	Member 2 Protein Solute Carrier Family 44IBA 11/01/2013 - "This novel mechanism of TRALI primarily mediated by endothelial cell dysfunction via choline transporter-like protein 2 may help to define new treatment strategies to decrease TRALI-related mortality." 07/01/2015 - "Choline Transporter-Like Protein-2: New von Willebrand Factor-Binding Partner Involved in Antibody-Mediated Neutrophil Activation and Transfusion-Related Acute Lung Injury." 12/01/2014 - "Transfusion-related acute lung injury-associated HNA-3a antibodies recognize complex determinants on choline transporter-like protein 2." 11/01/2013 - "Antibodies against human neutrophil antigen-3a (HNA-3a) located on choline transporter-like protein 2 induce severe transfusion-related acute lung injury (TRALI). " 05/01/2012 - "Recent reports have shown that the HNA-3a leukocyte antigen, a target for antibodies that cause severe transfusion-related acute lung injury, correlates with an arginine 154 (rather than glutamine) polymorphism in choline transporter-like protein 2 (CTL2) but did not show directly that R154 determines HNA-3a. "
10.	DiureticsIBA 12/01/2019 - "The management strategies for TRALI include withholding the transfusion, positive pressure breathing support, and diuretics. " 01/01/2006 - "The third patient, a 1-yr-old male, was diagnosed as transfusion associated circulatory overload (TACO) and "Possible TRALI," although his RF improved after treatment with diuretics. " 01/01/2022 - "Common interventions following TRALI diagnosis included mechanical ventilation with positive end-expiratory pressure, inhaled high-flow oxygen, inhaled pulmonary vasodilator, and pharmacologic treatment using pressors or inotropes, corticosteroids, or diuretics. "

Therapies and Procedures

1.	Blood Transfusion (Blood Transfusions) 07/01/2012 - "Blood Transfusion Services have adopted a number of different strategies for reducing the incidence of TRALI, but, while these have been successful, TRALI has not been completely eliminated. " 12/01/2013 - "Further studies are necessary to confirm the role of LPA in the pathogenesis of adverse effects of blood transfusion, especially TRALI." 09/05/2023 - "The clinical manifestations of the patient were consistent with those of TRALI after blood transfusion. " 01/01/2023 - "TRALI is a serious complication and the second leading cause of death related to blood transfusion. " 06/25/2022 - "Surgical cases requiring blood transfusion should be carefully monitored, and prompt action should be taken when TRALI occurs."
2.	Blood Component Removal (Apheresis) 01/01/2018 - "The use of platelet additive solutions was associated with a significant reduction in the incidence of TRALI following transfusion of buffy coat-derived platelet concentrates but not following transfusion of apheresis platelets. " 01/01/2018 - "Policy measures intended to reduce antibody-positive TRALI were found effective for apheresis platelet concentrates and fresh frozen plasma but not for whole blood-derived platelet concentrates. " 11/01/2015 - "The present study assessed CD62P accumulation during storage of apheresis platelet concentrates (A‑Plts) and established a mouse model of TRALI to further investigate the roles of CD62P in TRALI. " 01/01/2016 - "TRALI was more likely after transfusion of apheresis PLTs than male-donor-predominant plasma or RBCs. " 01/01/2016 - "The overall rate of TRALI was significantly higher for apheresis PLTs (6.2 cases per 10(6) units; OR [95% CI], 3.3 [2.3-4.8]) or plasma (3.8 cases per 10(6) units; OR [95% CI], 2.0 [1.4-2.9]) compared to RBCs (1.9 per 10(6) units). "
3.	Resuscitation 03/01/2017 - "This study examines the occurrence of TRALI with FFP resuscitation of critically ill burned patients. " 08/01/2017 - "Association of Massive Transfusion for Resuscitation in Gastrointestinal Bleeding with Transfusion-related Acute Lung Injury." 03/01/2017 - "The possible occurrence of TRALI in burn patients receiving FFP resuscitation should be weighed against the reported benefits of such a resuscitation strategy." 01/01/2006 - "Based on a review of the clinical and laboratory data and applying the Canadian guidelines, the first patient, a 67-yr-old man with chronic myelomonocytic leukemia, was diagnosed as "TRALI" due to the sudden onset of RF requiring intensive resuscitation. " 05/01/2008 - "Being elderly (aged > or = 65 years) and undergoing multiple blood transfusions in the early phase were independent risk factors correlated with secondary sepsis, deterioration of pulmonary function and transfusion-related acute lung injury due to early multiple fluid resuscitation."
4.	Noninvasive Ventilation 09/01/2012 - "Non-invasive ventilation for severe TRALI and myocardial stunning: report and literature review." 09/01/2009 - "TRALI improved with non-invasive ventilation support and use of high dose corticosteroids."
5.	Plasmapheresis 11/01/2020 - "She could not tolerate plasmapheresis due to transfusion-related acute lung injury but responded well to corticosteroids and discontinuation of nivolumab. "