How can TRALI be distinguished from TACO in a patient with respiratory distress after transfusion?

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The key idea is distinguishing noncardiogenic edema from fluid-overload edema after a transfusion. Transfusion-related acute lung injury causes noncardiogenic pulmonary edema due to inflammatory injury to the lungs, leading to hypoxemia and bilateral infiltrates without signs of volume overload. It typically develops within 6 hours of transfusion and patients do not show the usual signs of fluid overload such as elevated filling pressures, JVD, or edema. Transfusion-associated circulatory overload, on the other hand, is a cardiogenic edema from fluid overload; you’ll see signs of volume overload—hypertension or raised blood pressure, elevated filling pressures, JVD, peripheral edema, and potentially a cardiomegaly pattern on imaging—with edema that responds to diuretics. Both conditions can occur within 6 hours of transfusion, but the presence or absence of volume overload signs and the heart’s role in driving the edema differentiate them.