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).
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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.