Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
TRALI, TACO and severe allergic transfusion reactions
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Breathlessness, hypoxia or collapse during transfusion
TRALI, TACO and anaphylaxis can look similar initially; stop exposure and treat airway, breathing and circulation before waiting for a definitive label.
Action: Stop the component, maintain intravenous access with 0.9% sodium chloride through new tubing, call for senior and critical-care help and assess ABCDE. Give high-concentration oxygen and monitor continuously. For anaphylaxis give intramuscular adrenaline 500 micrograms into the anterolateral thigh and repeat after 5 minutes if airway, breathing or circulation problems persist. Sit an overloaded patient upright and give intravenous loop diuretic with ventilatory support; use supportive oxygen or ventilation for TRALI and avoid reflex diuresis unless hydrostatic overload also exists. Notify the transfusion laboratory immediately.
Synopsis
Differentiate the principal respiratory transfusion emergencies, deliver syndrome-specific oxygen, diuresis or adrenaline and preserve evidence for transfusion investigation.
First-line shared action is stop the transfusion, keep access with new saline tubing, perform ABCDE and contact the transfusion laboratory.
TRALI causes non-cardiogenic pulmonary oedema during or within six hours, with hypoxaemia and bilateral infiltrates not mainly explained by hydrostatic pressure.
TRALI often features fever or hypotension with normal or low JVP; treat with oxygen and lung-protective ventilatory support, not routine diuresis.
Key red flags
Stridor, tongue or airway swelling, wheeze, persistent hypotension or collapse indicates anaphylaxis even when urticaria is absent.
Investigation priorities
01
First-line: clinical phenotype and fluid balanceFirst stepFirst line
Separate airway allergy, permeability oedema and hydrostatic overload quickly.
Management branches
Acute respiratory reactionStop and phenotype while supporting ABC
Breathlessness, hypoxia, wheeze or collapse begins during or shortly after transfusion.
Stop the component, maintain access through new tubing, give oxygen, call senior help and notify the transfusion laboratory.
Look immediately for airway swelling, wheeze, rash, JVP, hypertension, fever, fluid excess, pain and dark urine.
Key medicines
Adrenaline for anaphylaxisGive 500 micrograms intramuscularly using 0.5 mL of 1 mg/mL adrenaline into the anterolateral thigh; repeat after 5 minutes if airway, breathing or circulation compromise persists while expert help is mobilised.
Furosemide for TACOGive 20 to 40 mg intravenously initially in a loop-diuretic-naive adult with clinically supported overload, then reassess urine output, blood pressure and respiratory response; a patient already taking loop diuretic commonly needs at least an equivalent or higher intravenous dose under the acute-heart-failure plan.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.