II. Epidemiology
- Incidence: 1 to 8% of transfusions
- Leading cause of transfusion-associated mortality
III. Pathophysiology
- Blood Product Transfusion volume results in Cardiogenic Pulmonary Edema
- Each unit of Blood Product ranges from 150 to 300 ml and initially, most of this remains intravascular
- Infused volumes may be large when multiple units are transfused
IV. Risk Factors
- Cardiomyopathy or chronic Congestive Heart Failure
- Chronic Kidney Disease
- Compensated Anemia
- Baseline volume overload
- Cancer
- Anticoagulation Reversal with plasma
- Very young (infants) and elderly
V. Differential Diagnosis
VI. Signs
- Fever
- Dyspnea
- Tachypnea
- Tachycardia
- Hypoxemia
- Hypertension
- Cardiogenic Pulmonary Edema related findings (distinguishes TACO from TRALI)
VII. Imaging: Chest XRay
- Bilateral Pulmonary Infiltrates
VIII. Labs
- NT-BNP elevated
- Contrast with normal level in TRALI
IX. Management
- Manage as acute Cardiogenic Shock
- Supportive Care
X. Prevention
- Slow transfusion to >4 hours
- Decrease transfusion volume