TRALI

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
urge

urge

Full Member
15+ Year Member
Joined
Jun 23, 2007
Messages
3,850
Reaction score
1,279
Members do not see this ad.
Does it really exist? I'm not convinced. There is too much stuff wrong with patients in the OR that need a blood transfusion. There is no test for it. I think what people go around calling trali is really TACO.

I have had a case or two where the lungs go bad and everyone claims trali but they end up shutting up when they realize that no blood was transfused.

What is the incidence of trali in patients who get a transfusion on the floor while watching tv?

Has any of you seen convincing trali?
 
Differential diagnosis
The differential diagnosis of acute lung injury after transfusion includes transfusion-associated circulatory overload (TACO), cardiogenic edema, allergic and anaphylactic transfusion reactions, and bacteremia/sepsis due to transfusion of bacterially contaminated blood products.

TRALI may be distinguished from TACO and cardiogenic pulmonary edema by the absence of signs of circulatory overload such as a normal central venous pressure (CVP) and normal pulmonary capillary wedge pressure (PCWP). Clinical response to diuretics also suggests a diagnosis of TACO rather than TRALI. Allergic and anaphylactic transfusion reactions may be manifest as hypotension and respiratory distress but are marked by laryngeal edema or bronchospasm with wheezing and a normal CXR. Transfusion transmitted bacteremia my present with fever, hypotension, and culminate in severe sepsis with associated acute lung injury which may be difficult to distinguish from TRALI. The presence of positive blood cultures is a useful delineating finding.

https://professionaleducation.blood...s/transfusion-related-acute-lung-injury-trali
 
Don't think it exists either, patient circling the drain --》 ARDS blamed on transfusion... i don't buy it. TACO is BS too btw: you don't get a volume overload with 500cc of blood.
 
In transfusion-related acute lung injury (TRALI),[11] plasma levels of brain natriuretic peptide (BNP) may be useful in distinguishing the cardiogenic pulmonary edema present in circulatory overload from the noncardiogenic pulmonary edema present in TRALI.[8] A hemolytic or septic reaction may present with similar symptoms as TRALI and should be excluded. In circulatory overload: Plasma levels of BNP may supplement clinical and radiologic findings.
 
Taco-vs-Trali.png
 
urge said:
Does it really exist? I'm not convinced. There is too much stuff wrong with patients in the OR that need a blood transfusion. There is no test for it. I think what people go around calling trali is really TACO.

I have had a case or two where the lungs go bad and everyone claims trali but they end up shutting up when they realize that no blood was transfused.

What is the incidence of trali in patients who get a transfusion on the floor while watching tv?

Has any of you seen convincing trali?
Click to expand...
I agree!
I think it is likely a combination of several issues in these critically ill patients: volume overload + some sort of sepsis + surgery induce inflammation syndrome + some degree of renal failure...
But some people with concrete thinking would rather attribute it to something as simple as a blood component transfusion and move on.
 
Planktonmd said:
I agree!
I think it is likely a combination of several issues in these critically ill patients: volume overload + some sort of sepsis + surgery induce inflammation syndrome + some degree of renal failure...
But some people with concrete thinking would rather attribute it to something as simple as a blood component transfusion and move on.
Click to expand...

Well someone at the ABA thinks it exists and likes to ask questions about it.
 
dhb said:
Don't think it exists either, patient circling the drain --》 ARDS blamed on transfusion... i don't buy it. TACO is BS too btw: you don't get a volume overload with 500cc of blood.
Click to expand...
Maybe a healthy young ASA 1 doesn't, but an elderly with undiagnosed diastolic dysfunction, who will go into pulmonary edema from 1L of IV crystalloid, will also get TACO big time from a couple of units given by some genius who thinks the elderly patient is tachycardic and SOB because of a Hgb of 6.8, and not that the patient has a Hgb of 6.8 from all the fluid already in him.

TRALI is actually pretty rare (didn't see even one in a year of fellowship, and I've seen tons of ARDS). TACO is much more frequent (even if we rarely call it so). Actually the most frequent is garden variety iatrogenic fluid overload by knee-jerk people. E.g. ICU patients who go to the OR on pressors and get liters of unnecessary fluids intraop (some people were never taught that one treats sepsis mostly with pressors, not fluids). 😛
 
Last edited by a moderator:
caligas said:
Well someone at the ABA thinks it exists and likes to ask questions about it.
Click to expand...
Well... there is a difference between reality and what the ABA thinks is reality, but if you are studying for your exams then, by all means, learn their version of reality!
Over the past few decades those of us who have been around have witnessed concepts and beliefs come and go, and it's not unusual for something to be taught as the absolute truth to be shown to be a pile of crap.
 
This is not the ABA. This is a critical care concept, so it's multidisciplinary.
 
I think it is usually very difficult to distinguish ARDS due to another cause from a true TRALI. My concept of TRALI is that in isolated incidents, it actually resolves more quickly than a case of true ARDS, so the natural history is a bit different. TACO is usually the culprit when a lung injury is suspected to be related to a transfusion. TRALI should be a diagnosis of exclusion because it does have implications on our resource utilization (notably the discontinuation of using a particular donor's blood products).
 
TRALI vs TACO is so rare as to not be something anybody will notice in anecdotal clinical practice. Those patients are sick and do have a lot going on. But it does exist.
 
Mman said:
TRALI vs TACO is so rare as to not be something anybody will notice in anecdotal clinical practice. Those patients are sick and do have a lot going on. But it does exist.
Click to expand...
My impression is that taco is very common. People tend to overload their patients with crystalloids and blood.
 
I honestly haven't heard about TACO until my fellowship, and I thought it was all just some bureaucratic invention. Which I still think it is, except that it happens. I just call it fluid overload. The fact that it's transfusion-associated should be absolutely irrelevant for clinical purposes, because it's not really a transfusion reaction, it's just volume-induced.

My guess is they singled it out as an entity because it's way more frequent than people think. Putting 500 cc of viscous colloid, in a short time, into a bad circulatory system will have consequences. Most elderly have undiagnosed diastolic dysfunction that people tend to forget about.
 
Last edited by a moderator:
FFP said:
I honestly haven't heard about TACO until my fellowship, and I thought it was all just some bureaucratic invention. Which I still think it is, except that it happens. I just call it fluid overload. The fact that it's transfusion-associated should be absolutely irrelevant for clinical purposes, because it's not really a transfusion reaction, it's just volume-induced.

My guess is they singled it out as an entity because it's way more frequent than people think. Putting 500 cc of viscous colloid, in a short time, into a bad circulatory system will have consequences. Most elderly have undiagnosed diastolic dysfunction that people tend to forget about.
Click to expand...
Agreed. I would say most of our pateints are volume overloaded in the post op period. Especially those who got blood since it cannot be 3rd spaced.
 
You must log in or register to reply here.

Similar threads

cockblockandrun
TRALI vs. Acute hemolytic reaction
Replies
9
Views
2K
proman
P
A
Low volume TRALI?
Replies
26
Views
3K
Apollyon
A
Top