Transfusion-related acute lung injury in a child with neuroblastoma during a late engraftment period of autologous stem cell transplantation.

TRALI is a rare and serious complication of blood product transfusion characterized by acute respiratory distress, non-cardiogenic pulmonary edema, hypoxia, fever, and hypotension developing during or up to six h following transfusion. The disease can be life-threatening and should be considered whenever complications occur after a transfusion in stem cell transplant recipients. Caution should be exercised as the symptoms of TRALI are similar to diseases such as pulmonary hemorrhage, pulmonary edema, and engraftment syndrome. The neutrophil engraftment generally occurs after 14 days following allogeneic stem cell transplants. The diagnosis of TRALI becomes very difficult with late engraftments. Herein, we report TRALI in a pediatric recipient whose neutrophil engraftment occurred on day 67.