# Recognition of Transfusion-Related Acute Lung Injury in a Patient With End-Stage Liver Disease and Sepsis

## TL;DR

A patient with liver disease and sepsis developed a severe lung injury after a blood transfusion, highlighting risks in such patients.

## Contribution

This case highlights the elevated risk of transfusion-associated reactions in patients with end-stage liver disease.

## Key findings

- The patient developed transfusion-related acute lung injury (TRALI) Type II after receiving packed RBCs.
- TRALI in sepsis patients with liver disease is associated with high morbidity and mortality.
- Management of TRALI in this population requires careful monitoring and early recognition.

## Abstract

A man in his 40s with history of decompensated cirrhosis presented with acute leg pain. On presentation, he was febrile, tachycardic, and jaundiced. Laboratory findings included leukocytosis with bandemia, anemia, elevated creatinine, hyponatremia, lactic acidosis, hyperbilirubinemia, and elevated INR. His model for end-stage liver disease-sodium (MELD-Na) score was 32. Diagnostic paracentesis did not suggest spontaneous bacterial peritonitis, but blood cultures revealed Escherichia coli. He received intravenous fluids, broad-spectrum antibiotics, and packed RBC. He became acutely dyspneic, 1 h into the transfusion. Over the next 36 h, he developed worsening hypoxia with infiltrates on serial chest x-rays despite adequate diuresis. He required intubation for respiratory failure and his hospital course was complicated by hepatic encephalopathy. Ultimately, he was discharged on hospital Day 18 and was retrospectively diagnosed with transfusion-related acute lung injury (TRALI) Type II. This case focuses on management of TRALI in sepsis and highlights the elevated risk of transfusion-associated reactions in liver failure patients and its mortality and morbidity.