Expert panel criteria for adjudication of acute posttransfusion hypoxemia with bilateral pulmonary infiltrates
| . | TRALI . | TACO . | TACO/TRALI . | Transfused ALI‡ . | Other . |
|---|---|---|---|---|---|
| Bilateral infiltrates on chest radiograph consistent with acute pulmonary edema* | Yes | Yes | Yes | Yes | No |
| Clinical evidence of left atrial hypertension as the principal explanation for acute pulmonary edema† | No | Yes | Indeterminate§ | No | NA |
| Presence of major ALI risk factor(s)‡ | No‖ | Yes/No | Yes/No | Yes | NA |
| . | TRALI . | TACO . | TACO/TRALI . | Transfused ALI‡ . | Other . |
|---|---|---|---|---|---|
| Bilateral infiltrates on chest radiograph consistent with acute pulmonary edema* | Yes | Yes | Yes | Yes | No |
| Clinical evidence of left atrial hypertension as the principal explanation for acute pulmonary edema† | No | Yes | Indeterminate§ | No | NA |
| Presence of major ALI risk factor(s)‡ | No‖ | Yes/No | Yes/No | Yes | NA |
NA indicates not applicable.
Atelectasis, pleural effusions, chronic interstitial infiltrates, or uninterpretable chest x-rays (resulting from poor quality) were considered not to be consistent with acute pulmonary edema.
A systematic integrated evaluation of hemodynamic monitoring (PAOP, CVP), echocardiography (ejection fraction, E/E′), chest radiographic imaging (vascular pedicle width, cardiothoracic ratio), laboratory findings (BNP and NT-ProBNP), and clinical course (rapid within hours resolution of acute respiratory failure after preload/afterload reduction would suggest hydrostatic TACO rather than ALI permeability pulmonary edema).
Major ALI risk factors included pneumonia, sepsis, aspiration, multiple fractures, and pancreatitis. “Transfused ALI” corresponds to “possible TRALI” according to the Canadian Consensus Conference.3 To select clear TRALI cases, these “possible TRALI” patients were not included in this study.
Insufficient data to make accurate determination or both conditions coexist.
Exception: If a patient with a major ALI risk factor was stable, the risk factor did not appear to cause ALI, and ALI was precipitated by the transfusion, then the patient was considered to have TRALI.