Transfusion-Related Acute Lung Injury (TRALI) in Postoperative Anesthesia Care Unit (PACU) After One Unit of Platelets: A Case Report

Abstract

Transfusion-related acute lung injury (TRALI) following transfusion of all plasma-containing blood products is a rare but serious syndrome characterized by the acute onset of non-cardiogenic pulmonary edema with severe hypoxemia with or without symptoms of hypotension, pinkish frothy secretions, fever, and cyanosis. In this report, we present a case of a 66-year-old female with a medical history significant for hypertension, hyperlipidemia, hepatitis C, liver cirrhosis, tobacco use disorder, metastatic spindle cell carcinoma of the lung status post chemotherapy who developed TRALI after administration of one unit of platelets. Although a rare occurrence, there can be a considerable risk of TRALI following transfusion of all plasma-containing blood products and there is great importance in considering each patient's risk factors for TRALI development prior to blood product administration.

Keywords: anesthesia recovery period; case reports; platelet transfusion; postoperative complications in the pacu; transfusion-related acute lung injury.

Figure 1. Chest X-ray displaying diffuse bilateral interstitial and airspace opacities suggestive of pulmonary edema.

Figure 2. Chest X-ray displaying worsening infiltrates bilaterally likely due to worsening pulmonary edema.

Figure 3. Timeline highlighting the case events.

Image credits: Kalei Lopez

Figure 4. CARE checklist.

The case report presented is in accordance with Case Report Guidelines (CARE).