Blood transfusion Transfusion-related acute lung injury: back to basics

Transfusion-related acute lung injury (TRALI) is a life-threatening disease affecting the lungs. TRALI can develop within 6 hours after transfusion and almost all patients with TRALI require mechanical ventilation at the intensive care department. Nevertheless up to 40% of patients do not recover from TRALI. Of all transfused patients, 0.05-15.1% develop TRALI. The majority of these cases is caused by antibodies in the transfusion product. However, in 20-50% of TRALI-cases it is unknown which factor in the transfusion product is responsible for this complication. This study investigated whether the storage time of red blood cell transfusion products is related to onset of TRALI. Healthy volunteers were injected with a parts of killed bacteria to induce symptoms of a mild blood poisoning. Thus the volunteers mimicked real intensive care patients. While the volunteers suffered from the flu-like symptoms, they received a transfusion of their own red blood cells. This blood had been stored for 2 or 35 days. After transfusion it was investigated whether the infusion of stored red blood cells had caused a decrease in pulmonary function. It was also studied whether the volunteers developed (mild) pulmonary inflammation. After transfusion it can be established whether a fresh or stored product was infused. However, transfusion of 35 days stored red blood cells was safe and had no adverse effect on the lungs. It was concluded that transfusion of stored red blood cells has no role in the onset of TRALI.