Q: Which lab tests may help in distinguish between Cardiogenic pulmonary edema and TRALI (Transfusion related acute lung injury) ?

Answer:

Brain natriuretic peptide (BNP) may be useful in distinguishing the cardiogenic pulmonary edema present in circulatory overload from the noncardiogenic pulmonary edema which is usually presents in TRALI.

Other laboratory findings may include unexpected haemoconcentration and a sudden fall in serum albumin. As in other causes of acute alveolar capillary leak, the pulmonary exudate in TRALI has a high albumin content. Also, Peripheral blood neutropenia has been reported but neutrophilia is more common.

Reference:

1. Skeate RC, Eastlund T. Distinguishing between transfusion related acute lung injury and transfusion associated circulatory overload. Curr Opin Hematol. Nov 2007;14(6):682-7

2. The pathology of transfusion-related acute lung injury. Am J Clin Pathol 1999; 112: 216–21