TRALI and availability bias


Availability bias is present in Medicine when we select and option as the more likely just because comes faster to our mind, related to previous experiencies.

TRALI : Transfusion-related acute lung injury (TRALI) is a clinical syndrome with a low prevalence, that presents as acute hypoxemia and noncardiogenic pulmonary edema during or after blood transfusion. The clinical picture and X-ray findings are similar to other diseases with specific treatment.

How these two concepts are related?


A 52-year-old man had a diagnosis of neoplasia and he received chemotherapy. Two weeks later neutropenia and anemia was present and a blood transfusion was started, but it has to be stopped due to the presence of fever and chills. One day later a second transfusion was administered with premedication, but the patient started again with fever and dyspnea. An x-ray showed a bilateral alveolar and interstitial infiltrate.

A young doctor with a previous experience of a similar situation , makes a diagnosis of TRAIL syndrome initially,but a positive sputum culture changed the diagnostic orientation.


Availability bias focus the mind over a narrow field and other pathological entities could be missed. Also specific treatment can be delayed. In this case a vivid and close experience changed the real prevalence of an uncommon situation like  the TRALI syndrome.

IMPROVING MEASURES: Make a complete list of possibilities. Give importance to prevalence. Remember that different entities can have the same radiological images.