Blood-transfusion related lung injury (TRALI) is an acute lung injury that occurs within six hours of a blood transfusion, characterised by sudden onset respiratory distress, hypoxaemia, and bilateral pulmonary infiltrates on imaging. It is significant in clinical practice due to its potential to cause severe morbidity and mortality, necessitating prompt recognition and management. A key association is the presence of anti-leukocyte antibodies in the donor blood, which can trigger an immune response in the recipient.