Recently two articles have been published in TRANSFUSION in which the authors propose to change the current definition on
transfusion-related acute lung injury (
TRALI). It was proposed to view
TRALI from the perspective of detectability versus nondetectability of leukoreactive
alloantibodies (Transfusion 2015;55:1128-34). The authors argue that only cases in which leukoreactive
alloantibodies can be detected should be defined as "true"
TRALI in analogy with the understanding of the pathophysiology of
heparin-induced
thrombocytopenia. In the other article (Transfusion 2015;55:947-52), the authors propose to redefine possible
TRALI to transfused
acute respiratory distress syndrome (ARDS) as their study in intensive care unit patients did not show a relation between the number of transfusions and possible
TRALI.We discuss these two propositions in light of the current evidence on pathophysiology of
TRALI and possible
TRALI. We argue that it is too early to redefine
TRALI, as 1) factors, such as storage time of platelets, which induce
TRALI in preclinical studies, have not yet been properly investigated in humans. Further research is needed on these agents before it is concluded that antibody-mediated
TRALI is the only "true"
TRALI. 2) In light of the current knowledge, it makes perfect sense that multiple transfusion is not related to possible
TRALI: ARDS risk factors in these patients result in a very sensitive equilibrium in which even only one transfusion induces
TRALI. Excluding possible
TRALI from the
TRALI definition would result in further underrecognition of
TRALI induced by
alloantibodies and interferes with exclusion of donors related to
TRALI cases and thus
TRALI prevention.