QuestionSBA
QuestionChoice
'Flash' pulmonary oedema can occur after an acute myocardial event or acute kidney injury. This is a possibility, however, the most likely diagnosis is TACO, caused by the infusion of large volumes of fluid in a patient with a background of heart failure.
10034849
c
Acute myocardial infarction causing flash pulmonary oedema
QuestionChoice
Pulmonary oedema caused by circulatory overload is the most likely diagnosis. The x-ray shows 'bat wing' alveolar oedema and fluid in the right horizontal fissure. The patient has received a significant amount of fluid via blood transfusions; each unit of packed red cells contains around 300ml, and each pool of FFP contains 200-250ml. The patient's background of HFpEF puts them at risk of this condition.
10034847
a
Transfusion-associated circulatory overload (TACO)
QuestionChoice
Anaphylaxis can occur following blood transfusion, however, it would usually present with hypotension and airway compromise (i.e. a mention of stridor). It would not typically cause the appearance of pulmonary oedema on a chest x-ray.
10034850
d
Anaphylaxis
QuestionChoice
Pulmonary haemorrhage is a rare (and often fatal) consequence of DIC. It is rare and may present with haemoptysis. The most likely diagnosis is TACO, caused by the infusion of large volumes of fluid in a patient with known HFpEF. Additionally, the infiltrates of diffuse pulmonary haemorrhage are usually described as 'fluffy', in contrast to the typical 'bat-wing' opacification seen in pulmonary oedema (and in this x-ray).
10034851
e
Pulmonary haemorrhage
QuestionChoice
While TRALI is a differential, it is rare, and TACO is the most likely diagnosis given the patient's background of HFpEF. Patients with TRALI may become hypotensive and febrile, as the pulmonary oedema is caused by neutrophil activation causing leakage in capillaries. TRALI may be considered more likely if there is an inadequate response to diuresis with furosemide.
10034848
b
Transfusion-associated lung injury (TRALI)
QuestionComment
spent so long looking for a blood pressure :( feel like this was way too vague icl
61731
QuestionComment
agreed
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Humerus H
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Defibrillator Dominant
Concept
Chapter
2693
6093
Blood Products, Groups and Transfusions
Topic
157
Haematology
19373
Transfusion-associated circulatory overload (TACO) can occur in patients with heart failure after significant fluid administration, leading to pulmonary oedema.
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Topic
157
Haematology
A 68-year-old lady is admitted to hospital with severe bleeding after a tooth extraction. She has a history of diabetes, hypertension, and heart failure with a reduced ejection fraction (HFpEF). Investigations showed a haemoglobin concentration of 34 g/L (normal range 115-155 g/L), with fragments on the blood film. Her D-dimer was raised, and clotting was significantly deranged, in keeping with disseminated intravascular coagulation (DIC).


She receives 5 units of packed red cells and 3 pools of fresh frozen plasma (FFP) as part of the major haemorrhage protocol.


She becomes acutely breathless and hypoxaemic, with saturations of 84% on air. A chest x-ray shows:


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Which of the following is the most likely diagnosis?
a