Abstract

RMAN TORRES, Roy; FERNANDEZ DELGADO, Norma D  and  TRUJILLO PUENTES, Hany Janet. TRALI, a masked menace: biology and pathophysiology. Rev Cubana Hematol Inmunol Hemoter [online]. 2015, vol.31, n.3, pp. 226-241. ISSN 1561-2996.

Transfusion-related acute lung injury (TRALI) defined as the onset of an acute respiratory distress in a recently transfused patient, has passed from been considered a rare complication of transfusion therapy to be the leading cause of transfusion-associated death, as reported by hemovigilance systems in Europe and America. In a previous paper definition, epidemiology and some clinical aspects of TRALI are reviewed. Now we focused our efforts in reviewing the incompletely understood world of its pathogenesis. Clinically recognizable TRALI´s development depends on the interaction between risk factors from both the transfused component unit (as the kind of component and substances within it) and receiver patient´s cellular response. Heterogeneity of clinical features, transfused volumes, component type and time elapsed from the beginning of transfusion to the onset of symptoms have pushed the explanations for its genesis to evolve in an effort to include as much cases as the different hypotheses allowed. Two interesting approaches to TRALI´s pathogenesis are the “two hit” theory and the “threshold” model imposed by risk factors interactions. The large diversity of variables and causes which can influence its onset and clinical recognition continue to make it a real challenge for clinicians, mainly within transfusion medicine, where the best therapeutic approach available is prevention.

Keywords : TRALI; pathophysiology; risk factors; HNA-3a; blood components; neutrophils; sCD40L.

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