Characterizing the epidemiology of postoperative transfusion-related acute lung injury.

TRALI is the leading cause of transfusion-related fatalities in the U.S. Estimates of incidence have ranged from 0.04 to 8.0% per transfused patient. Of note, a decline in the incidence after the introduction of universal leucoreduction and the male-only policy for plasma was reported. In the present study the impact of these interventions was evaluated in non-cardiac surgical patients before and after the introduction of leucoreduction and male-only policy for plasma.

TRALI / possible TRALI incidences were evaluated. Univariate analyses were used to compare associations between patients characteristics, transfusion details and TRALI mitigation strategies before and after implementation of leucoreduction and male-only policy.
The overall rate of TRALI occurrence was 1.3%. No significant reduction in the incidence of TRALI occurred before and after mitigation strategies. Thoracic, vascular, and transplant surgeries carried the highest rates of TRALI / possible TRALI while obstetric and gynaecologic patients had no TRALI episodes. TRALI / possible TRALI incidence increased with larger volumes of blood product transfused.

The authors conclude that further studies are necessary to idedntify specific risk factors for TRALI / possible TRALI in surgical populations.

– Rainer Moog

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