One hour after receiving a unit of pooled platelets, a ventilated post-operative patient develops acute hypoxaemia with PaO2/FiO2 of 150, bilateral infiltrates on chest radiograph, and fever. CVP is 9 mmHg and there is no clinical volume overload. Which statement about this complication is correct?

• A It results from hydrostatic pulmonary oedema and responds promptly to diuretics
• B It typically presents 24 to 72 hours after transfusion
• C It is caused by bacterial contamination of the platelet concentrate
• D Donor anti-HLA or antigranulocyte antibodies binding recipient neutrophils mediate the lung injury ✓

Explanation

This is transfusion-related acute lung injury (TRALI): new hypoxaemia with bilateral infiltrates within 6 hours of transfusion, without circulatory overload (wedge pressure not raised, CVP normal). Pathogenesis involves passive transfer of donor anti-HLA or antineutrophil antibodies that activate recipient pulmonary neutrophils. Bacterial contamination causes sepsis with shock, not isolated non-cardiogenic pulmonary oedema.

Reference: Williams Hematology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.