Transfusion related acute lung injury is one of the most important causes of morbidity and mortality associated with transfusions. It is characterized with non cardiac pulmonary edema. The exact mechanism is not known because there are limited cases and studies in this subject. It can be seen after any type of blood and blood product transfusions. Herein, we present a case that developed thrombocytopenia, platelet transfusion resistance, acute renal failure and transfusion related acute lung injury after administration of chemotherapy for refractory anemia with excess blasts.