A 58-year-old woman develops acute respiratory distress with bilateral pulmonary edema, fever, and hypotension within 2 hours of receiving 1 unit of packed red blood cells during a hysterectomy. Chest X-ray shows diffuse bilateral infiltrates without cardiomegaly. Echocardiography shows normal left ventricular function. There is no prior history of cardiac disease. The most likely diagnosis is:

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

Explanation

TRALI presents with acute non-cardiogenic pulmonary edema within 6 hours of transfusion, with normal left ventricular function, and no evidence of volume overload. It is the leading cause of transfusion-related mortality. TACO is distinguished by evidence of volume overload (elevated BNP, cardiomegaly, hypertension rather than hypotension) and responds to diuresis. The normal echocardiogram and absence of cardiac history rule out cardiogenic causes.

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

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Written and medically reviewed by the StethoPrep medical team.