Transfusion-related pulmonary complications in paediatric acute myeloid leukaemia: A case report of transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI).

BACKGROUND

Pulmonary complications of transfusion are a leading cause of morbidity and mortality. Transfusion-associated circulatory overload (TACO) is the most common, whereas transfusion-related acute lung injury (TRALI) is less frequent but potentially fatal.

OBJECTIVE

To describe a pediatric case with overlapping features of TACO and TRALI following platelet transfusion and to highlight diagnostic and management challenges.

METHODS

We report the case of a 15-year-old patient with acute myeloid leukemia who developed acute respiratory compromise after platelet transfusion. Clinical findings, laboratory data (including pro-BNP), imaging, and immunologic investigations were evaluated.

RESULTS

Elevated pro-BNP levels and signs of fluid overload were consistent with TACO. However, chest radiography demonstrated non-cardiogenic pulmonary edema, and pre-existing pulmonary involvement supported a diagnosis of type II TRALI. Management included immediate cessation of transfusion, oxygen therapy, and comprehensive evaluation with cytokine profiling, antibody screening, and advanced immunologic testing.

CONCLUSION

This case illustrates the diagnostic complexity of transfusion-related pulmonary complications, particularly when TACO and TRALI features overlap, and underscores the importance of a multidisciplinary approach to management and investigation.