Case 90 – update 2

Our patient is treated for potential pulmonary oedema associated with blood transfusion (transfusion-associated circulatory overload). The differential was TRALI but given its rarity and the patient’s observations (hypertension and a positive fluid balance) TACO was felt to be more likely. His post transfusion Hb was 105g/l having had two units (he weighs 48kg). After 40mg of IV furosemide he has a good diuresis and within 24 hours his oxygen saturations have normalised.

A week later he is reviewed prior to colonoscopy. He is feeling more fatigued and his daughter thinks he looks yellow. Blood tests reveal:

  • Hb 75g/l
  • WCC 10.8×109/l
  • Neutrophils 6.9×109/l
  • Platelets 450×109/l
  • Bilirubin 52μ/l



  • What complication of transfusion has happened?
  • What investigations would you do now to confirm?


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