SHOT Annual Report 2009 - Serious Hazards of Transfusion

Figure 15
Summary of cases
Assessment of TRALI Cases
There is no diagnostic test for TRALI and it is easily confused with other causes of acute lung injury, circulatory overload
or infection. More than one cause may have contributed to the respiratory impairment in many cases and TRALI may
co-exist with other conditions. The likelihood of TRALI has been assessed in each case. Clinical factors which influence
this assessment of cases include: time from transfusion to respiratory deterioration; radiological features; possibility
of infection; other risk factors for ALI/ARDS; evidence of circulatory overload and/or impairment of cardiac function;
pre-existing cardiac, pulmonary, renal or other disease; fluid balance in the previous 24 to 48 hours and response to
diuretics. Serological results are also taken into account. Cases are still included in this report if it is thought that both
TRALI and another risk factor such as cardiac failure contributed to the clinical events.
Two intensive care specialists and a transfusion medicine expert (TRALI expert panel) have initially assessed the cases
concerning NHSBT components (17 of 21 cases) before laboratory investigation has commenced. NIBTS are now also
referring cases to the intensive care specialists for assessment. A transfusion medicine specialist, who has previously
reviewed SHOT TRALI cases for the past 6 years, has subsequently assessed all cases including the results of TRALI
investigations. Complete results of investigations were not available in 4 cases; 1 of these was not investigated because
the TRALI expert panel considered that the clinical picture was much more likely to be due to alternative reasons.
As in previous years, cases were divided into 4 groups (as shown in Figure 15):
highly likely – where there was a convincing clinical picture and positive serology
probable – where there was either a less convincing history and positive serology or a good history and less
convincing or absent serology
possible – where either the clinical picture or serology was compatible with TRALI, but other causes could not
be excluded
unlikely – where the picture and serology were not supportive of the diagnosis
108 13. Transfusion-Related Acute Lung Injury (TRALI)