Transfusion-related acute lung injury (TRALI) is the most common cause of transfusion-related
morbidity and mortality in the United States. It is very common and often unrecognized in the
critically ill with the greatest incidence occurring in bleeding patients with liver disease.
Plasma is the most blood component associated with this deadly complication and therefore
patients with liver disease who frequently receive transfused plasma are at increased risk.
The optimal plasma transfusion strategy for bleeding patients with liver disease is unknown
and the investigators will evaluate this clinical question in a small pilot randomized
controlled trial. The invstigators hypothesize that targetting a more restrictive INR Target
(2.5) vs. an INR Target (1.8) will result in less hypoxemia, a TRALI surrogate without
increasing bleeding complications.