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Helpful features in distinguishing TRALI and TACO

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.
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