Transfusion-related acute lung injury (TRALI) after surgical resuscitation in renal trauma patients: A case report

Within 6 hours post-blood product transfusion, TRALI manifests as non-cardiogenic pulmonary edema. Bilateral pulmonary infiltrates, hypotension, fever, and respiratory failure are potential clinical manifestations. A 15-years-old boy underwent surgical resuscitation after a traffic accident which caused grade 5 kidney rupture, nephrectomy was then performed. Intraoperatively the patient received a transfusion of 800 mL whole blood and 600 mL packed red cell. Post-operatively, there was hypotension, tachycardia, and PCV mode ventilator was installed with bilateral rhonchi breath sounds. Supporting the diagnosis of TRALI, the chest x-ray revealed bilateral infiltrates. In this case, the risk factors for TRALI are the quantity of units transfused and the utilization of mechanical ventilation. Supportive management in the form of adequate oxygenation and ventilatory support resulted in a good outcome where the patient was improving from the 4th day post-operative. In accordance with the literature, the TRALI prognosis with adequate ventilator management is good.