2025 Volume 29 Issue 1 Pages 143-148
Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion. In this case report, we described a case of TRALI after withdrawal of cardiopulmonary bypass (CPB) during cardiac surgery. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was eventually required to save the patient’s life. A 74-year-old man presented with severe mitral regurgitation, moderate tricuspid regurgitation, and atrial fibrillation. The patient underwent mitral valve replacement, tricuspid valvuloplasty, and left atrial appendage closure. After weaning from CPB, platelet transfusion was initiated because of low platelet counts. A few minutes after the start of the transfusion, the ventilation volume decreased, and arterial blood gas analysis showed poor oxygenation with a PaO2/FiO2 ratio of 76. Large amounts of foamy secretions were continuously aspirated from the tracheal tube, and the patient developed hypovolemic shock.
Transesophageal echocardiography revealed normal left heart function and no evidence of pulmonary congestion. TRALI was suspected to be the cause of hypoxia. Methylprednisolone and sibelestat were administered, and nitric oxide inhalation was initiated. However, hypoxia persisted, and VV-ECMO was instituted to save the patient’s life. After admission to the intensive care unit, the patient’s oxygenation and chest radiography findings improved over time, and he was weaned from VV-ECMO and ventilator on postoperative days three and seven, respectively. In cases of severe TRALI, it is important to promptly administer ECMO to ensure adequate oxygenation.
