TRALI

allnurses Guide · Dec 22, 2009

i have found that transfusion related acute lung injury (trali) has been getting more popular in our peer discussions. this is a rare but potentially fatal condition that is the result of blood transfusions. it is unpredictable has nothing to do with the nurse administration or the lab. as far as i know it's just about a faultless event. i have found that not only have my fellow nurses had not being aware of this. but also some mds are not that informed about it as well.. okay my question is related to the fact that when we get the blood consent we always address the usual complications of transfusion. are we obligated to tell the pt about this rare but potential fatal complication? and if we share with them ,that this has been found to occur anytime between 1-6hrs post infusion, would they be granted to stay in the unit for 6hrs and delay discharge? my concern is mostly related our out patient transfusions that we do in our med unit. the typical "transfuse 2 units of rbc and discharge" type patients. does anybody have any thoughts on this thanks

trali/noncardiogenic pulmonary edema is rare complication in

informed consent: "consent must be informed to ensure that the patient (or guardian) has sufficient information about the procedures and their risks to make a reasonable and prudent decision whether to consent. it is generally accepted that not all risks need be detailed--only risks that are realistic and have resulted in complications in similar patients with similar problems. it is generally advisable to inform the patient that some complications may be life-threatening." from clinical anesthesiology 4th ed. morgan et al.

i would tell my patients that there are potential for complications with any medicine or procedure specifically with blood transfusions you could have something as a common as a low grade fever, to something as uncommon as a bacterial infection, a rare viral infection, and/or life-threatening complications.

i don't see a reason to hold a patient for potentially rare complications. you don't hold patient after giving vaccines or other medications in case of rare delayed reactions. patients should receive discharge instructions (written and verbal) on what to do for complications/life threatening and otherwise.

iluvivt, BSN, RN · Dec 22, 2009

Yes......I agree with the above....pts need to be told about all the potential complications. We do not keep them in our Outpatient Suite after a blood transfusion either....BUT what you do have to do is to perform good teaching and then documentation of that teaching. So tell your patients the s/sx that may indicate a delayed reaction...from mild to severe and what actions to take if any shoud occur....Do you have a discharge teaching sheet that you give them post transfusion..that is what we do and we can verbally highlight anything we choose

allnurses Guide · Dec 22, 2009

Isn't it most common with the transfusion of fresh frozen plasma?

allnurses Guide · Dec 22, 2009

Yes......I agree with the above....pts need to be told about all the potential complications.

Actually, what I was trying to convey with the post is that with informed consent patients do not need to be told every potential complication (you would be there all day if you covered every potential complication). The patient only needs to be informed about the most pertinent and that life threatening complications that may occur. Also, it is not legally required to cover all potential complications to obtain informed consent.

allnurses Guide · Dec 22, 2009

Isn't it most common with the transfusion of fresh frozen plasma?

I had never heard that before, but here is an article from medscape that gives some more facts about TRALI.

"Which blood products may induce TRALI in a patient? Most, if not all, blood products have been linked to TRALI: whole blood, red blood cells, platelets (whole blood- or apheresis-derived), and granulocytes. TRALI has been found to be only rarely associated with administration of cryoprecipitates and intravenous immunoglobulins. Plasma, on the other hand, seems to be the blood product most frequently associated with TRALI, particularly units that contain more than 100 mL of plasma."

http://www.medscape.com/viewarticle/460253_3