TRALI risk factors

Q: All of the following are risk factors for Transfusion-related acute lung injury (TRALI) except? 

A) Liver transplantation surgery 
B) High peak airway pressure on mechanical ventilator 
C) Negative fluid balance 
D) Emergent cardiac surgery 
E) Hematologic malignancy


Answer: C

The list of risk factor for TRALI is very long and growing day by day as with more recognition of this syndrome. Some risk factors are very well known such as high interleukin (IL)-8 levels, massive transfusion, sepsis, mechanical ventilation, and a high Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Others are less well known as described in the choices A, B, D and E. Other less well-known factors for TRALI are a positive fluid balance (choice C), transfusion of platelet or plasma, recipient female gender, smoking, history of alcohol abuse, intravenous immune globulin preparations, female donor, and increased parity.

#hematology
#pulmonary


References:

1. Vlaar AP, Binnekade JM, Prins D, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Crit Care Med 2010; 38:771. 

2. Toy P, Gajic O, Bacchetti P, et al. Transfusion-related acute lung injury: incidence and risk factors. Blood 2012; 119:1757. 

3. Vlaar AP, Hofstra JJ, Determann RM, et al. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study. Blood 2011; 117:4218. 

4. Gajic O, Rana R, Mendez JL, et al. Acute lung injury after blood transfusion in mechanically ventilated patients. Transfusion 2004; 44:1468. 

5. Rizk A, Gorson KC, Kenney L, Weinstein R. Transfusion-related acute lung injury after the infusion of IVIG. Transfusion 2001; 41:264. 

6. Gajic O, Yilmaz M, Iscimen R, et al. Transfusion from male-only versus female donors in critically ill recipients of high plasma volume components. Crit Care Med 2007; 35:1645.