TRALI (Transfusion Associated Lung Injury): thought to be reaction to antibodies within the plasma component of transfusion, with resultant acute lung injury w/non-hydrostatic pulmonary edema; can occur with infusion of any blood products (e.g. PRBCs, platelets, cryo, FFP)
TACO (Transfusion Associated Circulatory Overload): acute sob related to volume and oncotic load (ie hydrostatic pulmonary edema) from PRBCs:
Febrile Non-Hemolytic Transfusion Reaction (FNHTR): most common type of transfusion reaction; caused by cytokines in transfused product (platelets or PRBCs) or recipient antibody-donor antigen reactions
Allergic: reaction to antigens in transfused product, most commonly associated with platelets
Acute hemolytic: response to mismatch of donors to recipient (clerical error or patient misidentification)
Other: delayed hemolytic (occurs in those who have had multiple transfusions in past; response to allergens); septic (from bacterial contamination of transfused products)
Risk Factors
TACO and TRALI can overlap
TACO: hx or risk of diastolic HF, recent infusion of volume (IVF, other blood products) w/positive fluid balance, older age, CKD
Acute transfusion reaction: incorrectly labeled blood specimen for typing, wrong product sent to wrong patient, failure to confirm at time of infusion
TRALI: w/in 6h (often w/in 1-2h) of receiving blood product; acute sob, can have fever
TACO: acute sob, within 6 hours (or less) of receiving PRBCs
FNHR: elevated temp; hypertension, chills, rigor
Allergic: ranges from mild to anaphylactic reaction; occurs during transfusion or w/in 4h of completion; wheezing; urticaria, erythema and edema most often affecting face, neck, chest; tachycardia and hypotension if severe
Acute hemolytic: Fever, chills, hypertension or hypotension, sob, flank pain, reddish urine, bleeding, oliguria; within minutes of starting to hours after transfusion
Delayed reaction: Symptoms often vague or inapparent, depending on degree hemolysis; can include fatigue, jaundice; 2 days to 1 month after transfusion; not acutely ill
TRALI: Fever, SOB, tachycardia, tachypnea, hypoxemia, sometimes hypotension, rales, not grossly volume overloaded
Allergic: wheezing, urticaria, erythema
Acute transfusion reaction: often with acute illness with hypo or hypertension, other
Delayed transfusion reaction: jaundice, pallor
Tests
CXR, BNP, chem, cbc, echo (to determine if patient has cardiac substrate for TACO), blood cultures (if concern about infection)
With hemolysis: elevated LDH, T bilirubin, decreased hemoglobin; hemoglobinuria; haptoglobin decreased (takes a while to get results, so not helpful acutely)
For acute transfusion reaction: check if blood is appropriately matched to patient; may have evidence DIC