A 70-year-old patient develops acute dyspnoea, bilateral pulmonary edema, and hypoxia within 6 hours of receiving 2 units of packed red blood cells. Blood pressure is elevated at 160/95 mmHg. JVP is raised. There is no fever or haemodynamic instability. What is the most likely diagnosis?

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

Explanation

TACO presents with acute pulmonary edema, hypertension, and raised JVP due to volume overload, typically within 6 hours of transfusion. TRALI also causes acute lung injury but is normotensive or hypotensive without signs of volume overload. Haemolytic reactions present with fever, hypotension, and haemoglobinuria. Bacterial contamination causes septic shock.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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