TRALI (Transfusion related acute lung injury) is characterized by rapid onset of respiratory distress following transfusion of blood products. We report a case of bilateral stone disease with hydronephrosis and hematuria. After surgery, following1 hour of 100 ml of blood transfusion, she developed severe respiratory distress with oxygen saturation 68%and sudden hypotension. The blood transfusion was stopped immediately and she was managed with mechanical ventilation that resulted in a gradual improvement of dyspnoea and oxygen saturation. There is wide discrepancy in literature with reported frequency as low as 1/557,000 RBC units and as high as 1/432 platelet units. The severity of symptoms can range from mild to severe, and the treatment requires oxygen support and mechanical ventilation. If treated properly, most patients with TRALI recover within 96 hours.