TRALI — RACP Adult Medicine MCQ

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ModerateHaematologyTRALIRACP Adult Medicine

A 55-year-old woman develops acute dyspnoea and bilateral pulmonary infiltrates on CXR within 4 hours of receiving a platelet transfusion. She has no fluid overload and BNP is normal. SpO₂ is 82%. What is the most likely diagnosis?

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Correct answer: E — TRALI

TRALI (transfusion-related acute lung injury) presents within 6 hours of transfusion with acute hypoxaemia, bilateral pulmonary infiltrates on CXR, and no evidence of circulatory overload (normal BNP, JVP not elevated – distinguishing it from TACO). It is caused by donor anti-HLA or anti-neutrophil antibodies activating recipient neutrophils in the pulmonary vasculature, causing capillary leak. Platelet transfusions (especially from multiparous female donors) carry the highest risk. Management is supportive (oxygen, mechanical ventilation if needed). Most patients recover within 48–72 hours.

Reference: National Blood Authority – 2024 – Patient Blood Management; ANZSBT – 2024