Case report

Transfusion related acute lung injury presenting with acute dyspnoea: a case report

Altaf Gauhar Haji¹ , Shekhar Sharma¹ , DK Vijaykumar¹ and Jerry Paul²

¹  Department of Surgical Oncology, Amrita Institute of Medical Sciences & Research Center, Ernakulam (682026), Kerala, India

²  Department of Anaesthesia, Amrita Institute of Medical Sciences & Research Center, Ernakulam (682026), Kerala, India

author email corresponding author email

Journal of Medical Case Reports 2008, 2:336doi:10.1186/1752-1947-2-336

Published:	28 October 2008

Abstract

Introduction

Transfusion-related acute lung injury is emerging as a common cause of transfusion-related adverse events. However, awareness about this entity in the medical fraternity is low and it, consequently, remains a very under-reported and often an under-diagnosed complication of transfusion therapy.

Case presentation

We report a case of a 46-year old woman who developed acute respiratory and hemodynamic instability following a single unit blood transfusion in the postoperative period. Investigation results were non-specific and a diagnosis of transfusion-related acute lung injury was made after excluding other possible causes of acute lung injury. She responded to symptomatic management with ventilatory and vasopressor support and recovered completely over the next 72 hours.

Conclusion

The diagnosis of transfusion-related acute lung injury relies on excluding other causes of acute pulmonary edema following transfusion, such as sepsis, volume overload, and cardiogenic pulmonary edema. All plasma containing blood products have been implicated in transfusion-related acute lung injury, with the majority being linked to whole blood, packed red blood cells, platelets, and fresh-frozen plasma. The pathogenesis of transfusion-related acute lung injury may be explained by a "two-hit" hypothesis, involving priming of the inflammatory machinery and then activation of this primed mechanism. Treatment is supportive, with prognosis being substantially better than for most other causes of acute lung injury.