TRALI: Transfusion-Related Acute Lung Injury

Advanced, Organ-Based and Clinical Sciences

When a blood transfusion is implicated in the development of ARDS, it is referred to as Transfusion-Related Acute Lung Injury (TRALI). Distinct from Transfusion Associated Circulatory Overload (TACO), TRALI occurs without evidence of excessive intravascular volume or cardiac compromise. Symptoms will manifest about 6 hours post-transfusion and present with non-cardiogenic pulmonary edema. Symptoms include fever, dyspnea, and severe hypoxia. Although all products can incite TRALI, administration of Fresh Frozen Plasma (FFP) is the greatest risk factor. Treatment, beyond stopping the offending transfusion is supportive. Although symptoms generally resolve within 96 hours, TRALI is the leading cause of transfusion-related death.1

Risk Factors for the Development of TRALI Table at

TRALI v. TACO Table at


    Gropper, Michael A., et al. Miller's Anesthesia. Elsevier, 2020.


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Eryn Thiele, MD