TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI) AFTER FRESH-FROZEN PLASMA IN A PATIENT WITH COAGULOPATHY

Transfusion-related acute lung injury (TRALI) is due to specific antig en-antibody reaction involving the donor's leucocyte or granulocyte an tibodies towards the recipient's antigens. Aggregation in small pulmon ary vessels occurs, leading to derangement of permeability. Case histo ry: TRALI after transfusion of four units of fresh frozen plasma (FFP) for factor V deficiency prior to elective cholecystectomy is presente d. Within a few minutes after the third unit of FFP a florid pulmonary oedema developed. Hypotension and hypoxia with SPO2 83-87% at FiO(2) 1.0 followed. Prompt monitoring of central haemodynamics revealed a no rmal cardiac index without pulmonary hypertension. The operation was t hen conducted as planned. The bilateral pulmonary oedema resolved afte r 72 hours with ventilatory support. The patient recovered without com plications. When tested postoperatively, the second unit of FFP contai ned granulocyte antibodies and the third unit contained HLA antibodies . The crossmatch of the patient's granulocytes and lymphocytes towards the two donors of the two units of FFP was positive. Conclusion: When TRALI is suspected the donor blood has to be tested against the recip ient. Ventilatory support of the patient is continued until adequate o xygenation is reached.