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Transfusion-related acute lung injury — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsTransfusion-related acute lung injurySCE Acute Medicine

A 58-year-old man receiving chemotherapy presents with sudden dyspnoea during a platelet transfusion. Temperature rises from 37.0 C to 39.1 C, BP falls to 86/50 mmHg, SpO2 is 84% on air, and chest radiograph shows new bilateral pulmonary infiltrates. JVP is not raised and echocardiography shows preserved left ventricular function. What is the most likely diagnosis?

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Correct answer: D — Transfusion-related acute lung injury

Acute hypoxaemia, fever, hypotension and non-cardiogenic pulmonary oedema within six hours of transfusion are most consistent with TRALI. TACO usually has hypertension, raised JVP and volume overload, which are absent here. Anaphylaxis would be dominated by airway, skin or circulatory features without bilateral infiltrates as the central feature. The transfusion should be stopped immediately and the transfusion laboratory informed.

Reference: BSH transfusion guidelines, SHOT guidance