Transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) are both complications of blood transfusion presenting with acute respiratory distress. Which feature BEST distinguishes TRALI from TACO?

• A TACO occurs within 6 hours and shows low BNP and low PCWP
• B TRALI is caused by circulatory overload and responds to diuretics
• C TRALI typically occurs within 6 hours of transfusion and is associated with normal/low BNP and non-cardiogenic pulmonary oedema (PCWP ≤18 mmHg) ✓
• D Both conditions are indistinguishable clinically and require the same treatment

Explanation

TRALI (non-cardiogenic pulmonary oedema) occurs within 6 hours of transfusion, is caused by anti-HLA or anti-HNA antibodies in donor plasma activating neutrophils and damaging pulmonary capillaries. Key distinguishing features: normal/low BNP (<250 pg/mL), no cardiomegaly, PCWP ≤18 mmHg (or no clinical evidence of circulatory overload). TACO (hydrostatic pulmonary oedema) shows elevated BNP (>500 pg/mL), cardiomegaly, and PCWP >18 mmHg, responds to diuretics. TRALI is treated with supportive care; diuretics are harmful in TRALI. TRALI is the most common cause of transfusion-related mortality.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.