How I diagnose and treat cardiorespiratory complications of transfusion

Cardiorespiratory complications after blood transfusion are the leading cause of transfusion-related morbidity and mortality worldwide. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the 2 most frequently reported cardiorespiratory complications, both of which have 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, interventions, and risk mitigation measures. Preventive measures have led to a significant reduction in TRALI, and TACO prevention is increasingly highlighted within hemovigilance. In this article, 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 in which TRALI and TACO are both present. Hemovigilance systems worldwide 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 the future challenges and research priorities in the field of cardiorespiratory transfusion-related complications.