Editorial I

Transfusion-related acute lung injury (TRALI)Ðunder-diagnosed and under-reported Transfusion-related acute lung injury (TRALI) is almost certainly under-diagnosed. Though ®rst described in 1957,1 many clinicians are unaware of the condition or may not recognize transfusion as the cause when it occurs. TRALI describes a particular form of acute respiratory distress syndrome (ARDS) that occurs after transfusion and which is caused by antibodies in plasma of a single donor unit reacting with leucocyte antigens in the recipient. The condition is characterized by the sudden onset of non-cardiogenic pulmonary oedema, often with marked systemic hypovolaemia and hypotension, occurring during or within a few hours of transfusion.2 Fever and rigours are reported, but may be absent or relatively mild. There is rapid onset of severe hypoxia, a chest radiograph typical o