Vlaar et al redefined the definition for Transfusion-Related Acute Lung Injury (TRALI). The authors are from multiple institutions in Europe and North America.
Classification:
(1) Type I TRALI
(2) Type II TRALI
Criteria for Type I TRALI:
(1) no risk factors for ARDS
(2) acute onset
(3) hypoxemia on room air (PaO2 to FIO2 ratio <= 300 or oxygen saturation < 90%)
(4) bilateral pulmonary edema on imaging
(5) no evidence of left atrial hypertension (LAH) OR LAH not a main contributor to the hypoxemia
(6) onset during or <= 6 hours after transfusion
(7) no temporal relationship to an alternative risk factor for ARDS
where:
• For altitudes > 1,000 meters the PaO2 to FIO2 ratio is multiplied by (barometric pressure)/760.
Criteria for Type II TRALI:
(1) stable respiratory status in the 12 hours prior to transfusion with - one of the following:
(1a) risk factors for ARDS
(1b) mild ARDS that deteriorates after the transfusion
(2) acute onset
(3) hypoxemia
(4) clear evidence of bilateral pulmonary edema on imaging
(5) no evidence of left atrial hypertension (LAH) OR LAH not a main contributor to the hypoxemia
(6) onset during or<= 6 hours after transfusion
