Muhammad Tariq Jamil, Zehra Nizar Dhanani, Qalab Abbas, Humaira Jurair, Farheen Karim Mahar, Anwarul Haque


Background: Transfusion-Related Acute Lung Injury (TRALI) is a major cause of transfusion-related morbidity and mortality in the intensive care unit setting. There is a paucity of such data from Pakistan. The purpose of this study is to assess the incidence and outcome of TRALI in critically ill children admitted in a pediatric intensive care unit (PICU) of Pakistan. Methods: This is a retrospective cohort study of all critically ill or injured children who developed TRALI or “possible” TRALI after blood transfusion based on Canadian Conference Consensus criteria in a closed multidisciplinary-cardiothoracic PICU from January 2012 to June 2016. The demographic, pertinent clinical data, transfusion-related variables and outcome of all cases of TRALI were recorded. Results: Of total 2975 admissions in the PICU during study period, 35.8% (1066) received 5124 blood components. Eleven cases developed TRALI in our cohort. The incidence of TRALI was 1.03% per patient transfused and 0.19% (19/100,000 per blood product transfused). Median age was 8 (range 1–14) yr., 70 % (n=8) were male. Mean PRISM-III score was 16.3±6.7. Mean time interval for onset of TRALI was 2.73±1.67 hr. The postoperative cardiac surgical and hematology-oncology patients were most common categories (63.6%). Plasma and platelets were the most commomly identified trigger of TRALI. The case-specific mortality was 63.6% and the overall mortality was 10.7% (p<0.0001). Conclusion: The incidence of TRALI in critically ill children is low, but is associated with high mortality. Critically ill children with high PRISM-III score, postoperative cardiac surgical and hematology-oncology patients are often affected by TRALI.

Keywords: transfusion, critically ill child, TRALI, outcome, incidence, Acute Lung Injury

Full Text:



Bateman ST, Lacroix J, Boven K, Forbes P, Barton R, Thomas NJ, et al. Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med 2008;17891):26–33.

Mazine A, Rached-D'Astous S, Ducruet T, Lacroix J, Poirier N. Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study. Ann Thorac Surg 2015;100(2):671–7.

Moiz B, Sharif H, Bawany FA. Transfusion related acute lung injury--TRALI: an under diagnosed entity. J Pak Med Assoc 2009;59(1):39–41.

Hendrickson JE, Hillyer CD. Noninfectious serious hazards of transfusion. Anesth Analg 2009;108(3):759–69.

Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion 1985;25(5):573–7.

Kleinman S, Caulfield T, Chan P, Davenport R, McFarland J, McPhedran S, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 2004;44(2):1774–89.

Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med 2005;33(4):721–6.

Dotis J, Stabouli S, Violaki A, Vogiatzi L, Mitroudi M, Oikonomou M, et al. Transfusion-related acute lung injury management in a pediatric intensive care unit. Hippokratia 2011;15(2):184–6.

Mulder HD, Augustijn QJ, van Woensel JB, Bos AP, Juffermans NP, Wösten-van Asperen RM. Incidence, risk factors, and outcome of transfusion-related acute lung injury in critically ill children: a retrospective study. J Crit Care 2015;30(1):55–9.

Gauvin F, Robillard P, Hume H, Grenier D, Whyte RK, Webert KE, et al. Transfusion-related acute lung injury in the Canadian paediatric population. Paediatr Child Health 2012;17(5):235–9.

Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996;24(5):743–52.

Lieberman L, Petraszko T, Yi QL, Hannach B, Skeate R. Transfusion-related lung injury in children: a case series and review of the literature. Transfusion 2014;54(1):57–64.

Stainsby D, Jones H, Wells AW, Gibson B, Cohen H. Adverse outcomes of blood transfusion in children: analysis of UK reports to the serious hazards of transfusion scheme 1996-2005. Br J Haematol 2008;141(1):73–9.

Wallis JP. Transfusion-related acute lung injury (TRALI)--under-diagnosed and under-reported. Br J Anaesth 2003;90(5)573–6.

Marik PE, Corwin HL. Acute lung injury following blood transfusion: expanding the definition. Crit Care Med 2008;36(11):3080–4.

Pediatric acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16(5):428–39.

Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307(23):2526–33.

Muller MC, van Stein D, Binnekade JM, van Rhenen DJ, Vlaar AP. Low-risk transfusion-related acute lung injury donor strategies and the impact on the onset of transfusion-related acute lung injury: a meta-analysis. Transfusion 2015;55(1):164–75.

Khan H, Belsher J, Yilmaz M, Afessa B, Winters JL, Moore SB, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 2007;131(5):1308–14.

Silliman CC, Boshkov LK, Mehdizadehkashi Z, Elzi DJ, Dickey WO, Podlosky L, et al. Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood 2003;101(2):454–62.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] []