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Perioperative Transfusion-Related Acute Lung Injury.

The paradox between transfusions being life-saving yet simultaneously life threatening is often an ethical juxtaposition that directly confronts perioperative health care providers involved in major surgery. Transfusion-related acute lung injury (TRALI) is a well-described adverse transfusion reaction and the leading cause of transfusion-related morbidity and mortality. It is often grossly defined as the onset of respiratory distress and injury temporally related to immediate blood product transfusion. TRALI was first described in 1951; however, it was not formally described as a distinct clinical entity until 1983 by Poposvky and Moore. The combination of a unified (although still debated) clinical definition in 2004, increased surveillance of this and other adverse transfusion reactions, and a surge in research studying transfusion reactions has helped broaden our understanding of risk factors, incidence, and pathogenesis of TRALI over the last decade. As a large proportion of transfusions occur in the perioperative period, it is not surprising that a handful of studies has been completed to characterize TRALI in this specific clinical context. This research has been consequential to our understanding of clinical manifestations, incidence, and associated risk factors specifically within the perioperative period. Perioperative health care providers should become familiar with such factors in order to mitigate the risk of developing TRALI for any transfused perioperative patient.