Hematology

TRALI vs TACO

Transfusion-associated lung injury vs circulatory overload

TRALI vs TACO
Feature	TRALI	TACO
Mechanism
Timing	During or within 6 h of transfusion (consensus definition)	During or shortly after transfusion, commonly within a 24 h surveillance window
Mechanism	Donor antibodies / neutrophil-priming mediators → acute non-cardiogenic lung injury	Transfused volume exceeds cardiovascular reserve → hydrostatic pulmonary edema
Assessment
BP	Often hypotensive	Often hypertensive
JVP / exam	Normal JVP; no peripheral edema	Raised JVP, peripheral edema, weight gain
Traps & pitfalls
BNP / NT-proBNP	Not diagnostic; may rise from critical illness itself	Pre-vs-post rise supports TACO but a single post-transfusion value is not decisive — use volume status and echo
Assessment
CXR	Bilateral infiltrates, normal cardiac silhouette	Congestion ± cardiomegaly, effusions
Echo	Normal filling pressures/function	Volume-overloaded ± systolic/diastolic dysfunction
Management
Response to diuresis	Minimal — it is not a volume problem	Prompt improvement
Treatment	Stop transfusion; supportive care incl. lung-protective ventilation if severe; report reaction; no diuresis-first strategy	Stop/slow transfusion, oxygen ± NIV, diurese; slower future infusions
Traps & pitfalls
Prevention	Avoid unnecessary plasma-rich exposures; risk-reduced plasma strategies per blood bank; transfuse only when indicated	Slow infusion rates, single-unit-at-a-time reassessment, prophylactic diuretic in high-risk recipients

Comparing: TRALI

During or within 6 h of transfusion (consensus definition)

Donor antibodies / neutrophil-priming mediators → acute non-cardiogenic lung injury

Often hypotensive

Normal JVP; no peripheral edema

Not diagnostic; may rise from critical illness itself

Bilateral infiltrates, normal cardiac silhouette

Normal filling pressures/function

Minimal — it is not a volume problem

Stop transfusion; supportive care incl. lung-protective ventilation if severe; report reaction; no diuresis-first strategy

Avoid unnecessary plasma-rich exposures; risk-reduced plasma strategies per blood bank; transfuse only when indicated

For healthcare-professional education. Clinical decisions require patient-specific assessment and local protocols.