A patient who receives a massive blood transfusion is at risk for acute (adult) respiratory distress syndrome (ARDS).


Multiple transfusion involves infusion of at least 10 units of whole blood or packed red blood cells within a 12 hour period (Hudson et al use >= 15 units within a 24 hour period).


Additional risk factors for ARDS in a patient having massive transfusions:

(1) pulmonary contusion from blunt trauma

(2) multiple fractures

(3) shock


Differential diagnosis:

(1) TRALI (above)

(2) congestive heart failure

(3) ARDS due to other cause such as sepsis, burn or smoke inhalation

(4) bone marrow embolism


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