Unmasking TRALI: a case report of multiple myeloma and transfusion-associated event

Abstract

Introduction and importance: Transfusion-related acute lung injury (TRALI) is a relatively rare but severe respiratory complication that can occur following the transfusion of blood products. Despite its infrequent occurrence, TRALI is a leading cause of transfusion-related mortality, underscoring the need for rapid diagnosis and appropriate management. However, diagnosis remains challenging due to its clinical overlap with other causes of acute respiratory distress syndrome (ARDS).

Case presentation: This report describes the case of a 57-year-old woman with multiple myeloma (MM) who developed acute respiratory distress consistent with TRALI 4 hours after receiving a whole blood transfusion for severe pancytopenia.

Clinical discussion: This case highlights the diagnostic difficulties in distinguishing TRALI from other post-transfusion complications, including transfusion-associated circulatory overload (TACO), allergic reactions, cardiac complications, and infectious processes. It also emphasizes the need for a high index of suspicion in susceptible patients. We discuss the potential risk factors, underlying pathophysiology, and essential elements of the differential diagnosis.

Conclusion: Increased awareness and early recognition of TRALI are essential for improving patient outcomes. Moreover, this case aligns with the existing literature by highlighting the diagnostic challenges and the importance of considering TRALI in patients with hematological malignancies who require transfusion support.

Keywords: TRALI; blood transfusion; case report; multiple myeloma; transfusion-related acute lung injury.

Figure 1.

Patient’s oral lesions. Multiple white patches located on the inner surface of the buccal area.

Figure 2.

Initial chest CT scan of the patient before blood transfusion. (A) Scout image. (B) Mediastinal window. (C) Pulmonary window. No obvious pathology was observed.

Figure 3.

Pulmonary CT angiogram after blood transfusion. (A) Scout image. (B) Pulmonary window. (C) Mediastinal window. Yellow arrow indicates the consolidation and blue arrows indicate ground glass opacities of patient’s lungs.