Abstract

Transfusion-Related Acute Lung Injury (TRALI) is a severe, life-threatening transfusion reaction characterised by the acute onset of non-cardiogenic pulmonary edema and hypoxemia occurring within six hours of blood product administration. A 55-year-old female with chronic iron deficiency anemia (Hb 7.1 g/dL) presented with fatigue, dyspnea, and melena, receiving one unit of packed red blood cells (PRBCs) while hemodynamically stable. After forty-five minutes of transfusion, she developed acute respiratory distress (SpO2 85%, RR 32, BP 90/55, HR 115, fever 38.5°C), bilateral crackles without Jugular Venous Distention (JVD) or S3, confirming TRALI over Transfusion associated circulatory overload (TACO). Transfusion was stopped; immediate management included BiPAP, high-flow oxygen, crystalloid bolus, norepinephrine, and diuretic avoidance. The patient showed significant recovery within 24 hours and was discharged on day 5 with no residual respiratory deficits and GI follow-up.

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