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Table 2 Proposed scheme of investigations for an adverse event following a transfusion

From: Transfusion related acute lung injury presenting with acute dyspnoea: a case report

S. No. Investigation Comment
1. ABO typing To confirm type
2. Direct anti-globulin test To exclude cross-match incompatibility
3. Complete blood counts Transient neutropenia is seen with TRALI
4. Peripheral blood film Hemolytic cells may be seen in cross-match reaction
5. Chest X-ray Needed to exclude pulmonary edema, pneumonia, other reasons for hypoxia
6. Blood cultures Bacterial contamination is a differential diagnosis
7. Anti-body panel Includes anti HLA-1 & HLA-2, anti granulocyte, anti monocyte, anti IgA
8. D-dimer/FDP To evaluate for deep vein thrombosis
9. ECHO For cardiac function status and fluid overload
10. ECG/Cardiac enzymes For cardiac function status (to exclude myocardial infarction)
11. Undiluted pulmonary edema fluid From endotracheal tube if present – can be diagnostic if fluid to serum protein ratio is >0.75
12. BNP Helps to rule out overload in difficult cases (TRALI more likely if BNP < 150 pg/ml)
  1. FDP: fibrin degradation products; ECHO: echocardiogram; BNP: B type natriuretic peptide