Roubinian et al identified factors that can help to differentiate transfusion-associated circulatory overload (TAC) from transfusion-related acute lung injury. The authors are from the Blood Systems Research Institute, the University of California San Francisco and the Mayo Clinic.
Patient selection: acute pulmonary transfusion reaction
Outcomes: TACO, possible TRALI or TRALI
Parameters:
(1) age in years
(2) serum BNP levels in pg/mL after transfusion
(3) 24 hour fluid balance in liters (positive balance indicates fluid overload)
(4) number of transfused blood products during or within 6 hours
|
Parameter
|
Finding
|
Points
|
|
age in years
|
<= 70 years of age
|
0
|
|
|
> 70 years of age
|
1
|
|
serum BNP
|
<= 1,000 pg/mL
|
0
|
|
|
> 1,000 pg/mL
|
1
|
|
24-hour fluid balance
|
<= 3 liters
|
0
|
|
|
> 3 liters
|
1
|
|
number of transfused blood products
|
higher number (>= 11)
|
0
|
|
|
lower number
|
1
|
Additional findings associated with TRALI:
(1) receipt of plasma or whole blood from a female donor
Additional findings associated wtih TACO:
(1) higher serum cystatin C
number of findings associated with TACO or possible TRALI =
= SUM(points for the 4 parameters)
Interpretation:
• minimum number of findings: 0
• maximum number of findings: 4
• The higher the number of findings the greater the likelihood of the patient having TACO or possible TRALI.
