A 75-year-old man with a history of congestive heart failure and chronic kidney disease receives 3 units of packed red blood cells over 6 hours for anemia (Hb 6.8 g/dL). Two hours after the third unit, he develops dyspnea, orthopnea, raised JVP, blood pressure 180/100 mmHg, and bilateral basal crackles. Chest X-ray shows cardiomegaly and pulmonary edema. The most likely diagnosis is:

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

Explanation

TACO is characterized by acute pulmonary edema with evidence of volume overload (raised JVP, hypertension, cardiomegaly) within 6-12 hours of transfusion. It is the most common cause of transfusion-related death in elderly patients with cardiac or renal compromise. TRALI presents with hypotension and normal cardiac function. TACO responds to diuresis and fluid restriction. Prevention involves slow transfusion rates and prophylactic diuretics in at-risk patients.

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

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Written and medically reviewed by the StethoPrep medical team.