EAJAIC
Eurasian Journal of Anesthesiology and Intensive Care

The Eurasian Journal of Anesthesiology and Intensive Care (EAJAIC) is an independent-unbiased, peer-reviewed, "double-blind", and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, differential diagnoses, editorial opinions, letters to the editor, and educational papers in anesthesiology, algology, and intensive care medicine.

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Case Report
Diagnostic challenges in distinguishing TRALI from COVID-19 ARDS
Abstract
Severe acute respiratory syndrome caused by the SARS-CoV-2 virus (COVID-19) presents with a wide spectrum of clinical manifestations, ranging from asymptomatic infection to acute respiratory distress syndrome (ARDS) and multiorgan failure. Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and is associated with significant morbidity and mortality. A 46-year-old male patient with known chronic kidney disease presented to the emergency department with dyspnea and cough. The patient oxygen saturation was 78%. Laboratory findings revealed elevated white blood cell count, C-reactive protein, and D-dimer levels, along with lymphopenia; hemoglobin level was 7.3 g/dL. Chest computed tomography demonstrated diffuse bilateral ground-glass opacities with focal areas of consolidation. The patient was monitored in the intensive care unit with nasal oxygen therapy. Following blood transfusion for anemia, respiratory status deteriorated at the sixth hour post-transfusion, necessitating endotracheal intubation and initiation of mechanical ventilation. The deterioration in the patient’s respiratory status requiring mechanical ventilation was attributed to several differential diagnoses, including ARDS secondary to COVID-19 or other microorganisms, TRALI, and transfusion-associated circulatory overload (TACO). Bedside chest radiography demonstrated bilateral diffuse pulmonary opacities. Transthoracic echocardiography showed no evidence of left atrial hypertension (LAH), thereby excluding TACO. Accordingly, in our patient, who had risk factors for ARDS but a stable respiratory status for 36 hours before transfusion, the diagnosis of Type II TRALI was considered. The patient was successfully extubated on day 9. Repeated SARS-CoV-2 PCR tests and rapid antibody tests were negative, and blood and urine cultures showed no growth. The patient was discharged to the ward on day 20. TRALI may develop even in the presence of risk factors for ARDS. For the differential diagnosis of TRALI, TACO, and ARDS, a comprehensive evaluation using clinical findings, laboratory parameters, and objective criteria such as echocardiography is recommended.

Keywords : ARDS, Covid-19, TACO, TRALI

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Article available in :
Volume 3, Issue 2, 2026
Page : 23-26
https://doi.org/10.51271/EAJAIC-0053
Article Information
Received : 05 Oca 2026
Accepted : 20 Şub 2026
Published : 16 May 2026
Corresponding Author :

Zeynep Koç: Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, Turkiye

[email protected]
Citation : Koç Z, Silay E, Gür A, Aydoğan S. Diagnostic challenges in distinguishing TRALI from COVID-19 ARDS. Eur J Anesthesiol Intens Care. 2026;3(2):49-52. doi:10.51271/EAJAIC-0053

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