Emergency Nursing Recognition of Clinically Suspected Transfusion-Related Acute Lung Injury Type II After...

Transfusion-related acute lung injury is a rare but potentially fatal transfusion reaction that can be difficult to recognize in critically ill emergency department patients. We report a 69-year-old man with suspected sepsis, gastrointestinal bleeding, severe thrombocytopenia, acute kidney injury, and vasopressor-dependent hypotension. He received 1 unit of leukocyte-reduced apheresis platelets followed by 2 units of packed red blood cells. Approximately 2.5 hours after transfusion completion, he developed a fever and acute hypoxemic respiratory deterioration, with oxygen saturation decreasing to 70% despite oxygen delivery by mask at 15 L/min. Because deterioration occurred within 6 hours after transfusion, transfusion-related acute lung injury and transfusion-associated circulatory overload were considered. Bedside point-of-care ultrasound showed bilateral B-lines, grossly preserved cardiac function, no obvious left ventricular systolic dysfunction, and no pleural effusion. N-terminal pro-B-type natriuretic peptide was 345 pg/mL. Formal echocardiography performed approximately 6 hours later showed a left ventricular ejection fraction of 57%, no significant valvular disease or pulmonary hypertension, and no reported volume overload. These findings did not strongly support isolated transfusion-associated circulatory overload or cardiogenic pulmonary edema. Based on the 2019 international consensus redefinition, the case was most consistent with clinically suspected transfusion-related acute lung injury Type II, although complete documentation confirming respiratory stability throughout the 12 hours before transfusion was not available. This case highlights the emergency nurse's role in recognizing posttransfusion respiratory deterioration, escalating care, and communicating with the interprofessional team. Point-of-care ultrasound should be used as an adjunctive bedside assessment rather than a confirmatory test.