A 62-year-old man develops acute dyspnea, hypoxemia, and bilateral pulmonary infiltrates on chest radiograph 90 minutes after receiving 2 units of packed red blood cells post-colectomy. There is no evidence of volume overload; central venous pressure is 6 mmHg and BNP is normal. What is the most likely diagnosis?

• A Transfusion-related acute lung injury (TRALI) ✓
• B Transfusion-associated circulatory overload (TACO)
• C Anaphylactic transfusion reaction
• D Bacterial contamination of blood product

Explanation

TRALI is defined as acute non-cardiogenic pulmonary edema occurring within 6 hours of transfusion in the absence of other risk factors for ARDS. It is caused by donor anti-HLA or anti-neutrophil antibodies activating pulmonary neutrophils. TACO presents with volume overload, elevated CVP, and high BNP. Anaphylaxis features urticaria, bronchospasm, and hypotension. Bacterial contamination causes fever, rigors, and shock. TRALI is managed supportively and is a leading cause of transfusion-related mortality.

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

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Written and medically reviewed by the StethoPrep medical team.