Step 1: TRALI (Transfusion-Related Acute Lung Injury) is a syndrome of acute respiratory distress occurring in close temporal relation to a transfusion.
Step 2: By definition, symptoms develop during the transfusion or within 6 hours of it. Hence the answer is 6 hours.
Step 3: The clinical picture is rapid-onset dyspnoea and tachypnoea, often with fever, cyanosis, and hypotension. Examination shows respiratory distress with pulmonary crackles but no signs of CHF or volume overload.
Step 4: The chest X-ray shows bilateral non-cardiogenic pulmonary oedema with patchy infiltrates that can progress to a complete white-out, indistinguishable from ARDS. The other time windows (12, 48, and 72 hours) are too long and do not match the TRALI definition.