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TRALI — RACP Adult Medicine MCQ

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ModerateHaematologyTRALIRACP Adult Medicine

A 50-year-old woman receiving her second unit of packed red blood cells develops acute dyspnoea, bilateral pulmonary infiltrates on CXR, and hypoxia (SpO₂ 82% on room air) within 2 hours. BP is 120/80 mmHg. BNP is normal. She has no cardiac history. What is the most likely transfusion reaction?

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Correct answer: E — Transfusion-related acute lung injury (TRALI)

Acute onset of bilateral pulmonary infiltrates and hypoxia within 6 hours of transfusion, normal BNP, normal cardiac function, and non-cardiogenic pulmonary oedema is TRALI. It is caused by donor antibodies activating recipient neutrophils in the pulmonary vasculature. Management is supportive (oxygen, possibly mechanical ventilation). Unlike TACO, diuretics are not helpful.

Reference: Australian Red Cross Lifeblood – 2024 – TRALI; ISBT 2024