TRALI vs TACO -

🩸 TRALI vs TACO

Feature	TRALI *(Transfusion-Related Acute Lung Injury)*	TACO *(Transfusion-Associated Circulatory Overload)*
Definition	Acute lung injury due to non-cardiogenic pulmonary edema, usually from donor anti-leukocyte antibodies	Acute cardiogenic pulmonary edema due to volume overload
Onset	Within 6 hours of transfusion	Within 6 hours, often during or shortly after transfusion
Pathophysiology	1. Donor anti-HLA or anti-neutrophil Abs → neutrophil activation in pulmonary capillaries 2. Two-hit hypothesis: underlying inflammation primes lungs	Excess volume or rapid transfusion → ↑ hydrostatic pressure → pulmonary edema
Risk Factors	– Multiparous female donors (sensitized) – Critical illness – Sepsis, surgery	– Elderly – Cardiac/renal dysfunction – Infants – High-volume/rapid transfusion
Clinical Presentation	– Acute hypoxemia – Dyspnea, cyanosis – Hypotension – Fever – No JVD or peripheral edema	– Dyspnea, orthopnea – Hypertension – JVD, S3 gallop – Peripheral edema
Chest X-ray	Bilateral fluffy infiltrates (non-cardiogenic edema)	Pulmonary edema + cardiomegaly, pleural effusions
BNP/NT-proBNP	Normal	Elevated
CVP/Echo findings	CVP normal or low Echo: normal LV function	↑ CVP Echo: may show LV dysfunction
PCWP (if measured)	Normal (<18 mmHg)	Elevated (>18 mmHg)
Fever/Leukopenia	Often present (due to inflammatory activation)	Usually absent
Treatment	– Stop transfusion – Supportive O2/ventilation – May need intubation – Avoid diuretics	– Stop transfusion – IV diuretics (e.g., furosemide) – Oxygen
Recurrence Risk	Avoid plasma from multiparous women donors	Prevent by slower infusion, volume limits
Mortality	Up to 10–25%	Low if treated promptly
Reportable Event	Yes – must be reported to blood bank/transfusion services	Yes

🔍 How to Differentiate in Exams or ICU:

Feature	TRALI	TACO
BNP	Normal	Elevated
JVD	Absent	Present
Response to Diuretics	No response (can worsen)	Improves
Chest X-ray	Pulmonary edema only	Cardiomegaly + edema
Blood Pressure	Often low or normal	Often high

🧠 Pathophysiology Brief:

🔸 TRALI:

“Two-Hit” Model:

First hit: Patient has underlying endothelial activation (e.g., sepsis, trauma).
Second hit: Transfused donor antibodies (anti-HLA, anti-HNA) activate neutrophils → capillary leak → non-cardiogenic pulmonary edema.

🔸 TACO:

Classic volume overload, often from:

Rapid or large volume transfusions
Poor cardiac/renal reserve
Inadequate monitoring of fluid status

🔬 Laboratory Aid:

BNP/NT-proBNP: Elevated in TACO; normal in TRALI
HLA/HNA antibody testing: Retrospective confirmation in TRALI
Echocardiography: Shows normal vs impaired cardiac function

🧴 Prevention Tips:

TRALI	TACO
Use male-only plasma donors	Infuse slowly (<2 mL/kg/hr)
Screen donors for anti-HLA Abs	Diuretic prophylaxis if at risk
Avoid unnecessary transfusions	Monitor input/output, weight, CVP

🛑 Both Conditions Require:

Immediate cessation of transfusion
Reporting to transfusion services
Close monitoring and supportive management