Review Question - QID 109458

This patient is presenting with shortness of breath shortly after a blood transfusion suggesting a diagnosis of transfusion-associated lung injury (TRALI). TRALI occurs due to donor antibody binding of recipient leukocytes.

TRALI is a common transfusion reaction that presents with shortness of breath and pulmonary edema on radiography that occurs roughly 30 minutes after a transfusion is initiated. The capillary leak that occurs in the pulmonary vasculature in TRALI is related to antibodies against recipient leukocytes, and cytokine activity. Management of TRALI is supportive therapy as TRALI resolves spontaneously.

Figure A is a chest radiograph that is within normal limits. Figure B is a chest radiograph demonstrating pulmonary edema which would occur in TRALI.

Incorrect Answers:
Answer 1: Trauma to lung tissue and capillaries represents a diagnosis of pulmonary contusion. Pulmonary contusion would present similarly to TRALI and with a similar chest radiograph. However, the time frame of this patient's presentation and association with transfusion makes TRALI a more likely diagnosis.

Answer 2: Decreased left ventricular contractility could occur if there is an electrical abnormality of the heart or in left-sided heart failure.

Answer 3: Pericardial fluid accumulation represents a diagnosis of cardiac tamponade and could result in findings of pulmonary edema on radiography. Ultrasound would demonstrate fluid compressing the heart.

Answer 4: Antibody binding of red blood cell antigens represents ABO incompatibility. Patient's would present with symptoms of hemolysis, as well as shortness of breath and dark urine that occurs during the transfusion.

Bullet Summary:
TRALI presents with shortness of breath and pulmonary edema on radiography 30 minutes after transfusion is initiated and occurs secondary to donor antibodies binding recipient leukocytes.