BACKGROUND AND OBJECTIVES: After its description more than 20 years ago, TRALI Transfusion Related Acute Lung Injury became the main cause of transfusion-related morbidity and mortality in the United States and England. Since reliable data on its epidemiology in Brazil are not available, the difficulty to diagnose, varied clinical presentation, and absence of specific laboratory data, case reports are important. This is the first report of this transfusion reaction indexed in the LILACS data base. CASE REPORT: A 36-year old female underwent mastectomy with microsurgical breast reconstruction under general anesthesia. Immediately after the transfusion of one unit of packed red blood cells in the post-anesthetic recovery room, she developed respiratory failure, which did not require reintubation. Supportive treatment was instituted in the intensive care unit after other diagnostic hypotheses were ruled out. She had a favorable evolution and was discharged from the hospital without sequelae. CONCLUSION: The importance of judicious blood transfusion is emphasized since, although disease transmission is rare, TRALI is not, but it is underestimated due to the diversity of diagnostic hypotheses. Therefore, the knowledge of this disorder and its dissemination, especially in our country, is important.