Which transfusion-related condition is a known cause of acute respiratory failure?

Which transfusion-related condition is a known cause of acute respiratory failure?

• A. Dehydration
• B. Pneumothorax
• C. Transfusion-related acute lung injury (TRALI)
• D. Pulmonary embolism

Answer: (C)

Transfusion-related acute lung injury is an immune-mediated reaction tied to a transfusion, causing sudden respiratory failure. It happens when antibodies or bioactive substances in donor blood activate the recipient’s neutrophils in the lungs, leading to capillary leak and non-cardiogenic pulmonary edema. The key clues are abrupt dyspnea and hypoxemia within about six hours of a transfusion, with diffuse bilateral infiltrates on chest imaging and a normal heart size (no signs of volume overload). This differentiates it from cardiogenic edema seen with transfusion-associated circulatory overload, which would show fluid overload signs. Management centers on stopping the transfusion immediately and providing supportive care—oxygen therapy and, if necessary, mechanical ventilation. Diuretics aren’t the main treatment since the issue is capillary leak, not fluid overload. Prevention strategies include using donor plasma less likely to contain offending antibodies and leukoreduction. Other conditions like dehydration, pneumothorax, or pulmonary embolism can cause respiratory distress, but they aren’t transfusion-related reactions and lack the specific timing and pathophysiology of TRALI.

Transfusion-related acute lung injury is an immune-mediated reaction tied to a transfusion, causing sudden respiratory failure. It happens when antibodies or bioactive substances in donor blood activate the recipient’s neutrophils in the lungs, leading to capillary leak and non-cardiogenic pulmonary edema. The key clues are abrupt dyspnea and hypoxemia within about six hours of a transfusion, with diffuse bilateral infiltrates on chest imaging and a normal heart size (no signs of volume overload). This differentiates it from cardiogenic edema seen with transfusion-associated circulatory overload, which would show fluid overload signs.

Management centers on stopping the transfusion immediately and providing supportive care—oxygen therapy and, if necessary, mechanical ventilation. Diuretics aren’t the main treatment since the issue is capillary leak, not fluid overload. Prevention strategies include using donor plasma less likely to contain offending antibodies and leukoreduction.

Other conditions like dehydration, pneumothorax, or pulmonary embolism can cause respiratory distress, but they aren’t transfusion-related reactions and lack the specific timing and pathophysiology of TRALI.