How I diagnose and treat cardiorespiratory complications of transfusion

Cardiorespiratory complications after blood transfusion are the leading cause of transfusion related morbidity and mortality world-wide. Transfusion-related acute lung injury (TRALI) and transfusion associated circulatory overload (TACO) form the top two most frequently reported cardiorespiratory complications, both with clear pathophysiology-based treatment algorithms. In the past decades translational research has increased understanding of mechanisms in place including patient and transfusion risk factors. This has led to updated international definitions, biomarker-based diagnostics, intervention and risk mitigation. Preventive measures have led to a significant reduction in TRALI and TACO prevention is increasingly highlighted within hemovigilance. In this paper clinical case scenarios illustrate the challenges of diagnosing, treating and finally classifying cardiorespiratory complications of transfusion. A background on current definitions, diagnostics and pathophysiological mechanisms will be given; as well as how to deal with cases where TRALI/ TACO mechanisms are both present and need for combination therapies. Hemovigilance systems world-wide are essential to provide insight into the incidence of transfusion complications. Furthermore, these systems provide a basis to discover new patient and transfusion risk factors and to better balance the down- and upside of a transfusion for a patient. Finally, we discuss future challenges and research priorities in the field of cardiorespiratory transfusion complications.