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TRALI: Transfusion Related Acute Lung Injury
Test CodePreferred Specimen
Setup Schedule
Do not collect on Friday, Saturday, or Sunday
Clinical Significance
TRALI is a clinically defined, rare complication of blood transfusion. International experts have defined it as the new onset of acute lung injury/adult respiratory distress syndrome during or within 6 hours of transfusion of any blood component. If there is a clear temporal relationship to an alternative causative risk factor for acute lung injury, the diagnostic terminology should be "possible TRALI" or "transfused ARDS" (ARDS - Acute Respiratory Distress Syndrome).
TRALI is currently one of the leading causes of transfusion mortality in the United States. It has been linked to all kinds of blood components including IV immunoglobulin and allogeneic stem cells. High-plasma-volume components such as plasma and apheresis platelets have consistently been shown to confer the highest TRALI risk, and so mitigation strategies at the supplier level are largely focused on those. Laboratory investigation of TRALI is complex and ideally will involve specialized testing of both recipient and the donor(s) of the unit(s) thought to be involved.
Performing Laboratory
- TRALI samples are sent to Vitalant in Sacramento at the request of the Pathologist after the transfusion reaction workup has been completed.
- The Pathologist will notify CCBC of a TRALI reaction, and will discuss testing with the CCBC Medical Director.
- If the two Medical Directors agree that testing is indicated, patient samples and donor samples (if they can be obtained later by CCBC) are drawn and sent to Vitalant.
- Complete the Vitalant “Trali Request for Histocompatibility Testing” form. Order the Patient – Routine Workup.
- Request that CCBC pickup and ship the samples to Vitalant.
- Save a copy of the Vitalant order form in the pending file.
