TRALI and TACO syndrome. Pathophysiology, diagnosis and treatment: a review

Abstract

INTRODUCTION: TRALI (transfusion-related acute lung injury) and TACO (transfusion-associated circulatory overload) are severe post-transfusion reactions with high hospital mortality, uncertainty in pathophysiologic mechanisms and a blurred clinical presentation often lead to these conditions being underdiagnosed or missed by clinicians. OBJECTIVE: To analyze and summarize the current understanding of the pathophysiology, differential diagnosis and treatment of TRALI and TACO syndrome. To highlight the best approaches and current practices to improve treatment efficacy and awareness among specialists. MATERIALS AND METHODS: Articles in the following databases were analyzed: PubMed, eLibrary. The main inclusion criteria were: free access to the full content of the publications, compliance with the review topics concerning pathophysiology, diagnosis and treatment of TRALI- and TACO-syndrome. Exclusion criteria: abstracts, conference proceedings and editorial letters, as well as publications not indexed in specialized abstract databases. RESULTS: This article presents the main reference points, thanks to which clinicians can make a differential diagnosis among posttransfusion complications and select the optimal treatment. Since TACO is a simulated cardiogenic pulmonary edema as a result of altered cytokine profile, and TRALI-syndrome is a consequence of specific immunologic conflict between donor and recipient after hemotransfusion, these conditions should be differentiated in the inpatient setting, and specialists should use the full range of modern laboratory and instrumental methods. CONCLUSIONS: Despite a large number of studies, the pathophysiologic mechanisms of TRALI and TACO remain somewhat unclear, and current approaches to diagnosis and treatment are not effective. Therefore, the existing gaps in the diagnostics of posttransfusion reactions should be clarified in further studies, and clinicians should be extra vigilant in their choice of diagnosis.