Acute onset (during or within 6 hours of transfusion)
Hypoxemia*
Bilateral infiltrates on frontal chest radiograph
No evidence of circulatory overload/left atrial hypertension
No pre-existing ALI/ARDS before transfusion
Same as for TRALI
ALI/ARDS risk factor¶ at time of transfusion
Must be absent
Must be present
The diagnostic criteria for TRALI and possible TRALI share the following features: acute onset of hypoxemia, bilateral infiltrates on frontal chest radiograph, and absence of circulatory overload as the primary etiology of respiratory insufficiency. For a diagnosis of TRALI to be made, all of these features must be present. In addition, there should be no pre-existing ALI/ARDS risk factors at the time of transfusion. If ALI/ARDS risk factors are present, the diagnostic terminology "possible TRALI" is appropriate.
PaO2: arterial oxygen tension; FiO2: fraction of inspired oxygen; SpO2: hemoglobin oxygen saturation. * Hypoxemia is defined as PaO2/FiO2 ≤300 or SpO2 <90% on room air or other clinical evidence of hypoxemia. ¶ Risk factors for ALI/ARDS include the following: aspiration, toxic inhalation, pneumonia, toxic contusion, near drowning, shock states, severe sepsis, multiple traumas, burn injury, acute pancreatitis, cardiopulmonary bypass, or drug overdose.
Modified from: Kleinman S, Caulfield T, Chan P, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 2004; 44:1774.
