Transfusion-related acute lung injury in cardiac surgery patients is characterized by pulmonary inflammation and coagulopathy: a prospective nested case-control study.

This is a very interesting and smart study. The study by Vlaar and colleagues helps us understand better what’s happening in TRALI patients.

This large and prolonged prospective study elegantly reveals several important issues:

1) TRALI is associated with an increase in systemic inflammation and coagulopathy, indicating impaired pulmonary fibrinolysis. This finding will probably help understand why blood transfusion is associated with deep vein and central device thrombosis in cancer patients.

2) TRALI is associated, mainly, with plasma and platelet transfusion. This will probably mandate physicians to avoid plasma transfusions and modify platelet products (unique donor and without plasma).

3) the incidence of TRALI is higher than that reported by hemovigilance systems. Even in the Netherlands, the incidence is as high as 2.4%, despite the non-use of plasma and platelets from female donors for transfusion.

4) TRALI should be avoided with autologous blood.

– José A. García-Erce