Transfusionrelated acute lung injury (TRALI-syndrome) in critical states and its prevention measures

Aim. To study the prevalence of transfusion-related acute lung injury (TRALI). Material and methods. A retrospective and prospective analysis of the medical histories of 3,750 women in labour and postpartum women with class III-IV (WHO) haemorrhage, 756 patients with acute gastroduodenal haemorrhage of ulcerative etiology, 150 victims of polytrauma complicated by massive haemorrhage was undertaken. In addition, the results of transfusion therapy of 7,325 oncological and haematological patients hospitalised at the Research Institute of Paediatric Oncology, Haematology and Transplantation named after R. Gorbacheva were analysed. Results and discussion. TRALI was diagnosed in 24 patients and “possible TRALI” in 5 obstetric patients, or 0.77% of cases. The frequency of TRALI and “possible TRALI” was 1 case per transfusion of 870.3 doses of donated blood and blood components. In surgical patients - 4 and 2 (0.79%) respectively (1 case per transfusion out of 765 doses of blood components). In polytrauma patients, the diagnosis of “possible TRALI” was made in 3 patients (2.0%). 4 cases of TRALI and 5 cases of “possible TRALI” were diagnosed in patients with oncological and oncohematological profiles. The frequency of TRALI and “possible TRALI” was 1 case per 16,155 transfusions. Conclusion. Transfusion of blood components is a high risk factor for the development of TRALI, especially from female donors with a history of multiple pregnancies and childbirth. In order to prevent TRALI, it is necessary to screen the blood of female donors for the presence of anti-HNA, anti-HLA antibodies, or to discontinue the clinical use of plasma-containing components of blood from female donors and to arrange for the preparation of platelet concentrate in an additional solution.