Transfusion related acute lung injury in a perinatal woman

We report the case of a 26-year-old female who underwent emergency caesarean section at a private hospital and was referred to the Government Maternity Hospital (GMH), Tiruapti for bleeding per vaginum 4 hours after delivery. She had received one unit of whole blood transfusion outside. Later, whole blood, platelets (n= 1 unit) and fresh frozen plasma (n= 2 units) were transfused over a period of 6 hours at GMH, Tirupati. Two hours there after, she complained of sudden breathlessness with cough. On examination, bilateral basal crepitations and wheezing were noted. Fall in oxygen saturation by pulse oximetry, hypotension, tachypnoea and mild fever were also noted. Chest radiograph showed bilateral frontal opacities. Possibility of transfusion-related acute lung injury (TRALI) was considered. Supportive treatment included supplemental oxygen through oxygen mask followed by assisted mechanical ventilation and the patient improved. The present case highlights the importance of transfusion related adverse events so as to facilitate prompt recognition and appropriate treatment at the right time.