Helpful features in distinguishing TRALI and TACO

Feature	TRALI	TACO
Body temperature	Fever may be present	Unchanged
Blood pressure	Hypotension may be present	Hypertension may be present
Respiratory symptoms	Acute dyspnea	Acute dyspnea
Neck veins	Unchanged	May be distended
Auscultation	Rales	Rales and S3 may be present
Chest radiograph	Diffuse bilateral infiltrates	Diffuse bilateral infiltrates
Ejection fraction	Normal	Decreased
PAOP	Most often 18 mmHg or less	Greater than 18 mmHg
Pulmonary edema fluid	Exudate	Transudate
Fluid balance	Neutral or negative	Positive
Response to diuretics	Generally not responsive	Significant improvement
White cell count	Transient leukopenia may be present	Unchanged
BNP or NT-pro-BNP	Within normal limits	Significantly elevated

Response to diuretics is one of the most useful means of distinguishing TRALI from TACO.

TRALI: transfusion-related acute lung injury; TACO: transfusion-associated circulatory overload; PAOP: pulmonary artery occlusion pressure; BNP: b-type natriuretic peptide; NT-pro-BNP: N-terminal pro-brain natriuretic peptide.

Modified with permission from: Skeate RC, Eastlund T. Distinguishing between transfusion related acute lung injury and transfusion associated circulatory overload. Curr Opin Hematol 2007; 14:682. Copyright © 2007 Lippincott Williams & Wilkins.

Graphic 86939 Version 5.0

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Helpful features in distinguishing TRALI and TACO