II. Epidemiology

  1. Incidence: 1 to 8% of transfusions
  2. Leading cause of transfusion-associated mortality

III. Pathophysiology

  1. Blood Product transfusion volume results in Cardiogenic Pulmonary Edema
  2. Each unit of Blood Product ranges from 150 to 300 ml and initially, most of this remains intravascular
  3. Infused volumes may be large when multiple units are transfused

IV. Risk Factors

  1. Cardiomyopathy or chronic Congestive Heart Failure
  2. Chronic Kidney Disease
  3. Compensated Anemia
  4. Baseline volume overload
  5. Cancer
  6. Anticoagulation Reversal with plasma
  7. Very young (infants) and elderly

V. Differential Diagnosis

VII. Imaging: Chest XRay

VIII. Labs

  1. NT-BNP elevated
    1. Contrast with normal level in TRALI

IX. Management

  1. Manage as acute Cardiogenic Shock
  2. Supportive Care

X. Prevention

  1. Slow transfusion to >4 hours
  2. Decrease transfusion volume

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