Transfusion related acute lung injury presenting with acute dyspnoea: a case report

We report a case of a 46-year old woman who developed acute respiratory and hemodynamic instability following a single unit blood transfusion in the postoperative period. Investigation results were non-specific and a diagnosis of transfusion-related acute lung injury was made after excluding other possible causes of acute lung injury. She responded to symptomatic management with ventilatory and vasopressor support and recovered completely over the next 72 hours.The diagnosis of transfusion-related acute lung injury relies on excluding other causes of acute pulmonary edema following transfusion, such as sepsis, volume overload, and cardiogenic pulmonary edema. All plasma containing blood products have been implicated in transfusion-related acute lung injury, with the majority being linked to whole blood, packed red blood cells, platelets, and fresh-frozen plasma. The pathogenesis of transfusion-related acute lung injury may be explained by a "two-hit" hypothesis, involving priming of the inflammatory machinery and then activation of this primed mechanism. Treatment is supportive, with prognosis being substantially better than for most other causes of acute lung injury.Transfusion-related acute lung injury (TRALI) is a frequently misdiagnosed, yet potentially fatal reaction following transfusion of blood products. There is much confusion in the literature regarding this entity because until recently, there was no uniform nomenclature, definition or diagnostic features described in relation to it.We describe a case report of TRALI, not because it is infrequent, unique or has never been described before, but to familiarize our colleagues with it. The intention of this article is to compile available information to educate ourselves to a potentially preventable life-threatening condition and the current guidelines for its management.A 46-year old woman of Indian origin complained of breathlessness along with chest discomfort in the ICU, where she was recuperating from a