Volume 22, Issue 3 (Autumn 2025)                   bloodj 2025, 22(3): 248-263 | Back to browse issues page

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Jafarpoury M R, Shiri Y, Yazdandoust E. Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO): Pathophysiology, Prevention and Management. bloodj 2025; 22 (3) :248-263
URL: http://bloodjournal.ir/article-1-1580-en.html
Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO): Pathophysiology, Prevention and Management
Mohammad Reza Jafarpoury , Yashar Shiri , Ehsan Yazdandoust *
Keywords: Blood Transfusion, Transfusion Reactions, Risk Factors, Transfusion-Related Acute Lung  Injury, Transfusion-Associated Circulatory Overload
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Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO): Pathophysiology, Prevention and Management
 ‎
Mohammad Reza Jafarpoury1, Yashar Shiri1, Ehsan Yazadandoust1

1Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
Received: 2025/04/09
Accepted: 2025/06/10
 





    https://doi.org/10.18502/avr.v34i2.18052

    



Citation:
Jafarpoury MR, Shiri Y, Yazdandoust E.  Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO): Pathophysiology, Prevention and Management. J Iran Blood Transfus. 2025: 22 (2): 248-263
    



Correspondence: Yazdandoust E., Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine P.O.Box: 14665-1157, Tehran, Iran.
Tel: (+9821) 88601573             
E-mail: yazdandouste@gmail.com		 A B S T R A C T
Background and Objectives
Transfusion-Related Acute Lung Injury (TRALI) and transfusion- associated circulatory overload (TACO) are among the leading causes of serious complications and mortality resulting from blood product transfusions. These reactions primarily occur within the first six hours post- transfusion and are classified as acute transfusion reactions. The aim of this review is to explore epidemiology of TRALI and TACO, along with their risk factors, pathophysiology, clinical manifestations, diagnostic approaches, management, and preventive strategies.
Materials and Methods
A comprehensive literature search was conducted using reputable databases, including Google Scholar, PubMed, and MEDLINE. A total of 104 studies published between 1996 and 2025 were analyzed and cited.
Results
TRALI is typically characterized by non-cardiogenic pulmonary edema, hypoxia, and respiratory distress. The immune mechanisms involved include the presence of anti-HLA and anti-HNA antibodies, as well as factors such as cytokines and active lipids that contribute to its development. In contrast, TACO primarily results from excessive volume or rapid infusion in high-risk patients such as elderly and patients with cardiac-renal impairment. Clinically, TACO presents with pulmonary edema, elevated venous pressure, and a favorable response to diuretics. The finding also highlights advancements in diagnostic approaches for TRALI and TACO driven by a deeper understanding of their pathophysiology. Preventive measures for TRALI, include the use of washed blood components and solvent-detergent plasma. For TACO, strategies such as reducing the blood product infusion volume or speed and administering diuretics prior to infusion could be effective in preventing.
Conclusions 
The present review demonstrated that implementing male-only plasma policies and donors screening for anti-HLA/HNA antibodies in centers that have adopted these measures has been associated with a decreased incidence of TRALI. From an epidemiological perspective. TACO is more frequently observed among elderly patients and those with underlying cardiac or renal diseases. Pathophysiologically, immune-mediated mechanisms play a central role in TRALI, whereas volume overload and pressure-related factors are predominant in TACO. The use of biomarkers such as BNP and NT-proBNP can may facilitate more accurate differentiation between these two complications. Continued progress in understanding their pathophysiology, developing diagnostic biomarkers, and implementing preventive strategies can contribute to reducing their incidence and enhancing transfusion safety.
Key words: Blood Transfusion, Transfusion Reactions, Risk Factors, Transfusion-Related Acute Lung  Injury, Transfusion-Associated Circulatory Overload
 
Copyright © 2025 Journal of Iranian Blood Transfusion, Published by Blood Transfusion Research Center.
This work is licensed under a Creative Common Attribution-Non Commercial 4.0 International license.




1- Acridine Orange
1- Biological safety cabinet
1- Platelet Concentrate
2- Food and Drug Administration
3- Normal Skin Flora
4- Platelet Rich Plasma-Platelet Concentrate
5- Eosin-Methylene blue
6- Thioglycolate
1- Acridine Orange
1- Biological safety cabinet
1- Platelet Concentrate
2- Food and Drug Administration
3- Normal Skin Flora
4- Platelet Rich Plasma-Platelet Concentrate
5- Eosin-Methylene blue
6- Thioglycolate

 
Type of Study: Review Article | Subject: Imunohematology
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