Transfusion-related acute lung injury (TRALI) in post-partum bleeding patient: A case report

Transfusion-related acute lung injury (TRALI) is a rare but fatal complication of blood transfusion. However, it is frequently under-reported and not diagnosed. We reported a 32-year-old pregnant woman at 30/31 gestational weeks who developed acute respiratory distress and hemodynamic instability during transfusion in the post-operative period. Diagnosis of TRALI was made after excluding other possible causes of acute lung injury. We treated the patient with conservative treatment in the obstetrics emergency room based on the initial examination results and scheduled for an elective cesarean section (C-section). Transfusions of packed red blood cells were planned to increase the Hb level. The patient suddenly experienced shortness of breath during the transfusion with a relative risk of 30–36×/min. The patient was given 10 lpm oxygen via a non-rebreathing mask, and oxygen saturation was 86%. The patient’s blood pressure was 88/40 mmHg, and heart rate was 126×/min. The transfusion was immediately stopped. Fluid resuscitation with a crystalloid solution for hemodynamic improvement was given when the patient was intubated. After several treatments, the patient’s condition was getting better. On day 4, hemoglobin level increased to 9.1 mg/dL, hematocrit 27.6%, leukocytes 9.660/µL, and platelets 72,000/µL. Ventilator weaning was done gradually, and the patient was finally extubated on the 5th day of treatment.