Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. It is characterized by injury to the alveolar-capillary membrane precipitated by transfusion factors, antibodies, and/or inflammatory mediators, in a susceptible host. In the absence of a specific test, TRALI is defined clinically as a syndrome of acute lung injury that develops during or within 6 h of transfusion. The absence of left atrial hypertension and large protein content of edema fluid may help differentiate TRALI from hydrostatic pulmonary edema. The treatment is supportive. The blood bank needs to be notified promptly so that an appropriate workup and prevention are initiated in a timely manner.