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Diagnostic criteria for transfusion-related acute lung injury (TRALI) and possible TRALI, as used since 2004

Diagnostic criteria for transfusion-related acute lung injury (TRALI) and possible TRALI, as used since 2004
  TRALI Possible TRALI
Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)
  • Acute onset (during or within 6 hours of transfusion)
  • Hypoxemia*
  • Bilateral infiltrates on frontal chest radiograph
  • No evidence of circulatory overload/left atrial hypertension
  • No pre-existing ALI/ARDS before transfusion 
Same as for TRALI
ALI/ARDS risk factor at time of transfusion Must be absent Must be present
The diagnostic criteria for TRALI and possible TRALI share the following features: acute onset of hypoxemia, bilateral infiltrates on frontal chest radiograph, and absence of circulatory overload as the primary etiology of respiratory insufficiency. For a diagnosis of TRALI to be made, all of these features must be present. In addition, there should be no pre-existing ALI/ARDS risk factors at the time of transfusion. If ALI/ARDS risk factors are present, the diagnostic terminology "possible TRALI" is appropriate.
PaO2: arterial oxygen tension; FiO2: fraction of inspired oxygen; SpO2: hemoglobin oxygen saturation.
* Hypoxemia is defined as PaO2/FiO2 ≤300 or SpO2 <90% on room air or other clinical evidence of hypoxemia. 
¶ Risk factors for ALI/ARDS include the following: aspiration, toxic inhalation, pneumonia, toxic contusion, near drowning, shock states, severe sepsis, multiple traumas, burn injury, acute pancreatitis, cardiopulmonary bypass, or drug overdose.
Modified from: Kleinman S, Caulfield T, Chan P, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 2004; 44:1774.
Graphic 64212 Version 4.0

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