Case 90 – update 1

Our patient has deteriorated towards the end of a two unit transfusion. He is short of breath and more hypoxic compared to previous. Observations are below:

  Before unit one Towards end unit two
Pulse 72bpm 98bpm
Blood pressure 100/70mmHg 130/90mmHg
Oxygen saturations 97% RA 91% RA
Respiratory rate 12rpm 20rpm
Temperature 36.6oC 36.9oC

 

A chest radiograph is obtained (AP)

CXR oedema

TeamHaem followers are concerned about transfusion associated circulatory overload (TACO) and transfusion-associated lung injury (TRALI). He is given oxygen and once sitting up feels better. He tells you he’s never had any heart problems before. His main problem is that his clothes no longer fit him due to weight loss.

 

Questions:

  • What are the risk factors for TRALI and TACO?
  • Is there a way to differentiate between the two?
  • How is TACO managed?
  • How is TRALI investigated?

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