Abstract
Transfusion-related acute lung injury (TRALI) usually occurs within 1-6 hours from the beginning of a blood transfusion. We report a case of TRALI who developed dyspnea 16 hours after transfusion. A 66-year-old man, having hepatocellular carcinoma, was admitted to our hospital because of aggravation of ascites and anemia. On the 4th hospital day he received two units of packed red cells. About 16 hours later, he developed severe dyspnea and was transferred to the ICU. Chest radiograph and CT revealed diffuse bilateral alveolar infiltrates like acute respiratory distress syndrome. Respiratory support with noninvasive positive pressure ventilation was started and sivelestat sodium hydrate and steroids were administered. In spite of the therapy, oxygen exchange was not improved and liver function was gradually aggravated. The patient died from multiple organ failure on 11th ICU day. Human leukocyte class II antibodies in transfused packed red cells were found to be positive. Whenever we transfuse blood we should be aware of TRALI and of the late onset type of this disease.
