Two Episodes of Transfusion-related Acute Lung Injury (TRALI) Occurring within a Short Period: A Case Report

Yuina Akagi; Shogo Murata; Yusuke Yamashita; Ken Tanaka; Takayuki Hiroi; Toshiki Mushino; Hiroki Hosoi; Akinori Nishikawa; Shinobu Tamura; Takashi Sonoki

doi:10.2169/internalmedicine.4700-20

This article has now been updated. Please use the final version.

Two Episodes of Transfusion-related Acute Lung Injury (TRALI) Occurring within a Short Period: A Case Report

Yuina Akagi, Shogo Murata, Yusuke Yamashita, Ken Tanaka, Takayuki Hiroi, Toshiki Mushino, Hiroki Hosoi, Akinori Nishikawa, Shinobu Tamura, Takashi Sonoki

Author information

Yuina Akagi
Department of Hematology/Oncology, Wakayama Medical University, Japan
Shogo Murata
Department of Hematology/Oncology, Wakayama Medical University, Japan
Yusuke Yamashita
Department of Hematology/Oncology, Wakayama Medical University, Japan
Ken Tanaka
Department of Hematology/Oncology, Wakayama Medical University, Japan
Takayuki Hiroi
Department of Hematology/Oncology, Wakayama Medical University, Japan
Toshiki Mushino
Department of Hematology/Oncology, Wakayama Medical University, Japan
Hiroki Hosoi
Department of Hematology/Oncology, Wakayama Medical University, Japan
Akinori Nishikawa
Department of Hematology/Oncology, Wakayama Medical University, Japan
Shinobu Tamura
Department of Hematology/Oncology, Wakayama Medical University, Japan
Takashi Sonoki
Department of Hematology/Oncology, Wakayama Medical University, Japan

Keywords: transfusion-related acute lung injury, two TRALI episodes, non-antibody-mediated TRALI, platelet transfusion

JOURNAL OPEN ACCESS Advance online publication

Article ID: 4700-20

DOI https://doi.org/10.2169/internalmedicine.4700-20

The final version of this article is now available: Vol. 59 (2020), No. 20 pp. 2577-2581

Details

Abstract

Transfusion-related acute lung injury (TRALI) is a non-hemolytic adverse reaction that occurs ≤6 hours after receiving a transfusion. A 72-year-old male with leukemia developed severe hypoxemia after platelet transfusions on two occasions within a 4-day period. During the first episode, the transfused platelet preparation was positive for anti-human-leukocyte antigen antibodies. The pathogenesis of TRALI includes an antibody-mediated mechanism and a non-antibody-mediated mechanism, in which various factors combine to activate pulmonary neutrophils. In our case, it is considered that the patient's neutrophils reached the activation threshold for the development of TRALI after the accumulation of various factors besides anti-leukocyte antibodies.

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