Clinical definitions for TACO and TRALI
| NHSN 2016-TACO definition24 . | ISBT 2011-TACO definition25 . | NHLBI Working Group 2005-TRALI definition26 . | Canadian Consensus Conference 2004-TRALI definition27 . |
|---|---|---|---|
| New onset or exacerbation of ≥3 of the following within 6 h of transfusion: | Any 4 of the following occurring within 6 h of completion of transfusion: | Patients without acute lung injury (ALI) risk factor(s) other than transfusion: | ALI: |
| (a) Acute respiratory distress (dyspnea, orthopnea, and cough) | (a) Acute respiratory distress | In patients with no ALI immediately before transfusion, a temporal association of transfusion and ALI is made if there is: | (a) Acute onset |
| (b) Evidence of positive fluid balance | (b) Tachycardia | (a) New ALI,96 and | (b) Hypoxemia: PaO2/FiO2 ≤ 300, or SpO2 < 90% on room air (or other clinical evidence of hypoxemia in a nonresearch setting) |
| (c) Elevated brain natriuretic peptide | (c) Elevated blood pressure | (b) The onset of symptoms or signs is during or within 6 h after the end of transfusion of 1 or more plasma-containing blood products | (c) Bilateral infiltrates on frontal chest radiograph |
| (d) Radiographic evidence pulmonary edema | (d) Acute or worsening pulmonary edema of frontal chest radiograph | (d) No evidence of left atrial hypertension (ie, circulatory overload) | |
| (e) Evidence of left heart failure | (e) Evidence of positive fluid balance | As there is no other ALI risk factor, the new ALI is inferred to be mechanistically related to transfusion (ie, TRALI) | No preexisting ALI before transfusion |
| (f) Elevated central venous pressure | Patients with ALI risk factor(s) other than transfusion: | During or within 6 h of transfusion | |
| In patients with no ALI immediately before transfusion, a temporal association of transfusion and ALI is made if there is: | No temporal relationship to an alternative risk factor for ALI | ||
| (a) New ALI,96 and | If clear temporal relationship to an alternative risk factor for ALI (in combination with previous listed criteria), then defined as “possible TRALI” | ||
| (b) The onset of symptoms or signs is during or within 6 h after the end of transfusion of 1 or more plasma-containing blood products | |||
| By assessing the patient’s clinical course, the new ALI is either: | |||
| (a) TRALI, and the new ALI is inferred to be mechanistically related to the transfusion, or both the transfusion and the alternative risk factor, or | |||
| (b) Not TRALI, and the new ALI is mechanistically related to the alternative ALI risk factor alone, whereas the transfusion is coincidental |
| NHSN 2016-TACO definition24 . | ISBT 2011-TACO definition25 . | NHLBI Working Group 2005-TRALI definition26 . | Canadian Consensus Conference 2004-TRALI definition27 . |
|---|---|---|---|
| New onset or exacerbation of ≥3 of the following within 6 h of transfusion: | Any 4 of the following occurring within 6 h of completion of transfusion: | Patients without acute lung injury (ALI) risk factor(s) other than transfusion: | ALI: |
| (a) Acute respiratory distress (dyspnea, orthopnea, and cough) | (a) Acute respiratory distress | In patients with no ALI immediately before transfusion, a temporal association of transfusion and ALI is made if there is: | (a) Acute onset |
| (b) Evidence of positive fluid balance | (b) Tachycardia | (a) New ALI,96 and | (b) Hypoxemia: PaO2/FiO2 ≤ 300, or SpO2 < 90% on room air (or other clinical evidence of hypoxemia in a nonresearch setting) |
| (c) Elevated brain natriuretic peptide | (c) Elevated blood pressure | (b) The onset of symptoms or signs is during or within 6 h after the end of transfusion of 1 or more plasma-containing blood products | (c) Bilateral infiltrates on frontal chest radiograph |
| (d) Radiographic evidence pulmonary edema | (d) Acute or worsening pulmonary edema of frontal chest radiograph | (d) No evidence of left atrial hypertension (ie, circulatory overload) | |
| (e) Evidence of left heart failure | (e) Evidence of positive fluid balance | As there is no other ALI risk factor, the new ALI is inferred to be mechanistically related to transfusion (ie, TRALI) | No preexisting ALI before transfusion |
| (f) Elevated central venous pressure | Patients with ALI risk factor(s) other than transfusion: | During or within 6 h of transfusion | |
| In patients with no ALI immediately before transfusion, a temporal association of transfusion and ALI is made if there is: | No temporal relationship to an alternative risk factor for ALI | ||
| (a) New ALI,96 and | If clear temporal relationship to an alternative risk factor for ALI (in combination with previous listed criteria), then defined as “possible TRALI” | ||
| (b) The onset of symptoms or signs is during or within 6 h after the end of transfusion of 1 or more plasma-containing blood products | |||
| By assessing the patient’s clinical course, the new ALI is either: | |||
| (a) TRALI, and the new ALI is inferred to be mechanistically related to the transfusion, or both the transfusion and the alternative risk factor, or | |||
| (b) Not TRALI, and the new ALI is mechanistically related to the alternative ALI risk factor alone, whereas the transfusion is coincidental |
NHLBI, National Heart, Lung and Blood Institute; NHSN, National Healthcare Safety Network.