Transfusion-Related Acute Lung Injury (TRALI)

What is transfusion-related acute lung injury (TRALI)?

Transfusion-related acute lung injury (TRALI) is a reaction to a blood transfusion that causes the air sacs in your lungs (alveoli) to fill with fluid. It can make it hard to breathe and cause your blood pressure to drop to dangerously low levels.

TRALI happens during or within six hours of a transfusion. While most cases of TRALI aren’t fatal, it’s a medical emergency. Call 911, go to the ER or alert your medical team at the hospital if you’re experiencing symptoms of TRALI.

What are the symptoms of TRALI?

Symptoms of TRALI include:

• Shortness of breath (dyspnea).
• Cough.
• Blue skin, lips or nails (cyanosis).
• Fever.
• Dizziness or lightheadedness.
• Fainting.

Symptoms of TRALI can start during or within six hours after the transfusion.

What causes TRALI?

TRALI happens when antibodies — part of your immune system that helps fight infections — in the donor blood latch on to your cells. This mistakenly alerts your immune cells that something harmful might be in your body. Your immune cells cause inflammation, damaging your lungs and blood vessels and allowing fluid to leak into your lungs.

Who’s at risk for TRALI?

While TRALI can happen to anyone after a transfusion, it’s more likely to happen to people who:

• Are on mechanical ventilation.
• Have alcohol use disorder.
• Use tobacco products.
• Have liver or kidney disease.
• Are very ill.

The type and amount of blood product you need can also increase your risk.

How is TRALI diagnosed?

A healthcare provider diagnoses TRALI after ruling out other causes of your symptoms (like anaphylaxis or infection). Your provider will get blood and imaging tests (like a chest X-ray or CT scan) to make a diagnosis. They may also perform an echocardiogram to see how well your heart’s working.

How do healthcare providers treat TRALI?

There’s no specific treatment to cure TRALI, but providers can keep you stable and monitor you until it resolves on its own. Providers may treat you with:

• Oxygen therapy.
• Vasopressors (medications that treat low blood pressure).
• Diuretics or IV fluids, depending on your situation.
• Mechanical ventilation.

Can TRALI be prevented?

There’s no way to completely prevent TRALI. But blood suppliers can screen donated blood to help reduce the risk of blood transfusion complications.

What can I expect if I have TRALI?

Most cases of TRALI get better in two to four days. During that time, providers will monitor you and give you supportive care (treat your symptoms and prevent complications) in the hospital.

When should I go to the ER?

Call 911, go to the emergency room or alert your care team at the hospital if you have a fever, shortness of breath, lightheadedness or other symptoms of TRALI after a blood transfusion.

A note from Cleveland Clinic

It can be scary to think that a procedure that’s supposed to help you get better can actually make you feel worse. Fortunately, while blood transfusions are very common, transfusion reactions like TRALI are not. But when they do happen, they can be life-threatening. If you experience any unusual symptoms after a blood transfusion, don’t hesitate to go to the ER or tell your medical team at the hospital. It’s important to get evaluated right away.