Transfusion related acute lung injury (TRALI), first described as a clinical entity in 1983, is characterized by acute non cardiogenic pulmonary oedema with hypoxia occurring within few hours of receiving blood products. It accounts for 1:5000 of all known transfusion reactions and is one of the leading causes of transfusion related death, approximately 5%. TRALI is thought to be underrecognised and under-reported. Suspected cases should be reported to the blood bank so any other products from the particular donor may be quarantined. The pathophysiology of TRALI involves increased permeability of pulmonary capillaries and elevated levels of protein in pulmonary effusions. Increased permeability of pulmonary capillaries may be due to the leukocyte antibodies in the donor blood, neutrophil priming activity by cytokines and lipids contained in the donor sample, or a combination of both mechanisms. Management of TRALI is primarily supportive. Most patients show dramatic clinical improvement within 48 hours and radiographic clearing of oedema within 4 days.