Transfusion related acute Lung. Injury (TRALI) is a clinical diagnosis of exclusion, characterized by acute respiratory distress and bilaterally symmetrical pulmonary oedema with hypoxaemia that develops within 2 to 8 hours after a transfusion.

Pulmonary vascular effects occur due to the cytokines present in the transfused product or from interaction between patient white cell antigens and donor antibodies (or vice versa).

Volume Overload:

Patients with cardiopulmonary disease and infants are at the risk of volume overload especially during rapid transfusion.

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Hypothermia:

Rapid infusion of large volumes of stored blood contributes to hypothermia. Infants are particularly at risk during exchange or massive transfusion.

Citrate toxicity:

Citrate is the anticoagulant used in blood products. Usually citrate is metabolized rapidly by the liver. Rapid administration of large quantities of stored blood may cause hypocalcaemia and hypomagnesaemia when citrate binds to calcium and magnesium.

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This can result in myocardial depression or coagulopathy. Patients most at risk are those with liver dysfunction or neonates with immature liver function having rapid large volume transfusion.

Potassium Effects:

Stored red cells leak potassium proportionately throughout their storage life. Irradiation of red cells increases the rate of potassium leakage. Clinically significant hyperkalaemia can occur during rapid, large volume transfusion of older red cell units in small infants and children.