A 58-year-old woman receives 2 units of packed red blood cells postoperatively. Six hours later, she develops acute hypoxaemic respiratory failure with bilateral pulmonary infiltrates on chest X-ray. She is afebrile, blood pressure is 110/70 mmHg, central venous pressure is 6 mmHg, and BNP is 120 pg/mL. Which is the MOST likely diagnosis?

• A Transfusion-related acute lung injury (TRALI) ✓
• B Transfusion-associated circulatory overload (TACO)
• C Anaphylactic transfusion reaction
• D Acute myocardial infarction

Explanation

TRALI presents with acute hypoxaemia and bilateral infiltrates within 6 hours of transfusion without evidence of left atrial hypertension. The normal central venous pressure and BNP below 250 pg/mL effectively rule out TACO, which is characterised by volume overload with elevated filling pressures and markedly raised BNP. Anaphylaxis would present with urticaria and bronchospasm.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.