TRALI (Transfusion Related Acute Lung Injury)

Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
1-8% of transfused critically ill patients developed TACO. Patients receiving a greater number of transfused units, larger plasma volumens transfused and faster rates of transfusion were more likely to develop TACO. Left ventricular dysfunction documented by echocardiogram before transfusion and FFP ordered to reverse anticoagulation treatment predicted the development of TACO.
Time to detection: 
< 6 hours
Alerting signals, symptoms, evidence of occurrence: 
Combination of clinical signs (including gallop, jugular venous distension, systolic hypertension), radiographic (cardiothoracic ratio > 0.53 and vascular pedicle width > 65mm), electrocradiagraphic (new ST-segment and T-wave changes), laboratory (elevated troponin T > 0.1 ng/mL), hemodynamic (PAOP > 18 mmHg, CVP >12), and echocardiographic findings (ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity, greater than 15 and/or ejection fraction of less than 45%, new presence of severe left-sided valvular hear disease (aortic or mitral stenosis or regurgitation) and the prompt response to appropriate therapy: dieuretic or vasodilator use, threatment of ischemia, and/or inotropic agents.
Demonstration of imputability or root cause: 
Signs and sypmtoms qualify as TACO.
Suggest references: 
Li, G., Rachmale, S., Kojicic, M., Shahjehan, K., Malinchoc, M. Kor, D.J. and Gajic, O. Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients. Transfusion 2011; 51(2):338-343.