Perioperative Transfusion-Related Acute Lung Injury

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The paradox between transfusions being life-saving yet simultaneously life threatening is often an ethical juxtaposition that directly confronts perioperative health care providers involved in major surgery. Transfusion-related acute lung injury (TRALI) is a well-described adverse transfusion reaction and the leading cause of transfusion-related morbidity and mortality.1–3 It is often grossly defined as the onset of respiratory distress and injury temporally related to immediate blood product transfusion. TRALI was first described in 1951; however, it was not formally described as a distinct clinical entity until 1983 by Poposvky and Moore.4 The combination of a unified (although still debated) clinical definition in 2004, increased surveillance of this and other adverse transfusion reactions, and a surge in research studying transfusion reactions has helped broaden our understanding of risk factors, incidence, and pathogenesis of TRALI over the last decade.

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