Transfusion Related Acute Lung Injury: A severe case triggered with anti-HLA class II antibodies in the recipient

Transfusion-related acute lung injury (TRALI) is a serious clinical syndrome associated with the transfusion of plasma-containing blood components. The classic TRALI syndrome is characterized by the suddenly onset of respiratory failure within 2-6 hrs of the transfusion of a blood product, generally transient, resolves within 48-96 hrs spontaneously, and has a better prognosis. Nonetheless there is an expanded definition of TRALI syndrome up to 72 hrs, which is called delayed TRALI. The potential causes of TRALI can be explained by two distinct mechanism including the anti-leukocyte antibodies in donor plasma or in recipient plasma with the reverse mechanism, and biological response modifiers in susceptible individuals. This report highlights the succesful management of a classic TRALI case that was seen approximately two hours after the transfusion of a packed red blood cell and triggered with anti-HLA class II antibodies in the recipient with reverse mechanism accompanied by neutropenia together.