Table 2. Key diagnostic features... | American Society of Hematology

Table 2.

Key diagnostic features differentiating TACO from TRALI

Key diagnostic feature	Specific diagnostic readout	TACO	TRALI
Acute onset of respiratory distress symptoms	Onset <6 h upon blood transfusion	Yes	Yes
Hypoxemia	SpO₂ < 90% or PaO₂/FiO₂ < 300 mm Hg on room air	Yes	Yes
Pulmonary edema	Bilateral infiltrates on chest radiograph	Yes	Yes
Alternative risk factors for ALI	eg, pneumonia, sepsis, aspiration, multiple trauma, acute pancreatitis	No	No
Alternative risk factors for ALI		No	Yes: possible TRALI
Hydrostatic pulmonary pressure increased	Pulmonary artery occlusion pressure >18 mm Hg	Yes	No
Protein-poor edema fluid	Edema or plasma protein concentration <0.65 at the onset of acute respiratory failure	Yes	No
Increased ventricular filling/myocardial stretching^32-34	B-type natriuretic peptide (BNP) >250 or pre-/posttransfusion BNP ratio >1.5 or N-terminal pro-BNP >1000 pg/mL	Yes	Yes*/No
Response to diuretics	Rapid and significant improvement	Yes	No
Cardiogenic nonlaboratory evidence for circulatory overload	Systolic ejection fraction <45 and no severe valvular heart disease on echocardiography	Yes	No
	Systolic blood pressure >160
	Vascular pedicle width >65 mm and cardiothoracic ratio >0.55 on chest radiograph
Cardiac ischemia	New ischemic changes on electrocardiography or new troponin T levels of >0.05	No	No

Key diagnostic feature	Specific diagnostic readout	TACO	TRALI
Acute onset of respiratory distress symptoms	Onset <6 h upon blood transfusion	Yes	Yes
Hypoxemia	SpO₂ < 90% or PaO₂/FiO₂ < 300 mm Hg on room air	Yes	Yes
Pulmonary edema	Bilateral infiltrates on chest radiograph	Yes	Yes
Alternative risk factors for ALI	eg, pneumonia, sepsis, aspiration, multiple trauma, acute pancreatitis	No	No
Alternative risk factors for ALI		No	Yes: possible TRALI
Hydrostatic pulmonary pressure increased	Pulmonary artery occlusion pressure >18 mm Hg	Yes	No
Protein-poor edema fluid	Edema or plasma protein concentration <0.65 at the onset of acute respiratory failure	Yes	No
Increased ventricular filling/myocardial stretching^32-34	B-type natriuretic peptide (BNP) >250 or pre-/posttransfusion BNP ratio >1.5 or N-terminal pro-BNP >1000 pg/mL	Yes	Yes*/No
Response to diuretics	Rapid and significant improvement	Yes	No
Cardiogenic nonlaboratory evidence for circulatory overload	Systolic ejection fraction <45 and no severe valvular heart disease on echocardiography	Yes	No
	Systolic blood pressure >160
	Vascular pedicle width >65 mm and cardiothoracic ratio >0.55 on chest radiograph
Cardiac ischemia	New ischemic changes on electrocardiography or new troponin T levels of >0.05	No	No

Modified from Gajic et al.³¹

In transfused critically ill patients.