this is cxr of 35yr old patient who is a chronic smoker since 10yrs ,met with an accident 3hrs back and brought to the ER and due to blood loss he was transfused IN FIXED COMPONENT RATIO with same blood group .after 4hrs patient developed breathlessness , cough and an xray chest was advised .what is the most common componet lead to this condition ?

Definition TRALI is defined as an acute lung injury that is temporally related to a blood transfusion; specifically, it occurs within the first six hours following a transfusion. * It is typically associated with plasma components such as platelets and Fresh Frozen Plasma, though cases have been repoed with packed red b coo c since there is some residual plasma in the packed cells. The blood component transfused is not pa of the case definition. Pathogenesis of TRALI The exact pathogenesis of TRALI is not known thus several theories have been proposed. Two basis mechanism have been proposed for the pathogenesis of TRALI for immune competent hosts. * It is hypothesized that TRALI may be precipitated by the infusion of donor antibodies directed against recipient leukocytes. The infusion of donor anti-HLA (human leukocyte antigens) or anti-HNA (human neutrophil antigens) antibodies is thought to directly cause complement activation, resulting in the influx of neutrophils into the lung, followed by neutrophil activation and release of cytotoxic agents, with subsequent endothelial damage and capillary leak . Immediate management of TRALI * Stop the transfusion immediately * Suppo the patient * If the patient is intubated, obtaine undiluted edema fluid as soon as possible(within 15 min) and simultaneous plasma for determination of total protein. * Obtain CBC with DC and chest radiography * Notify the blood bank of possible trali request a different unit and quarantine other unit from the same donor ref : robbins 10th ed