# An 82-year-old client with CHF develops acute dyspnea, jugular venous distention, hypertension, and crackles 90 minutes into a 2-unit PRBC transfusion. Which is the most likely reaction and priority action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391884&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

An 82-year-old client with CHF develops acute dyspnea, jugular venous distention, hypertension, and crackles 90 minutes into a 2-unit PRBC transfusion. Which is the most likely reaction and priority action?

## Option

1. Anaphylaxis — administer epinephrine
2. Septic reaction — administer antibiotics
3. TRALI — administer 2L bolus and continue
4. TACO (transfusion-associated circulatory overload) — slow or stop the transfusion, sit upright, supplemental O2, IV diuretic (furosemide), notify provider **✔ Correct answer**

**Correct answer: 4**

## Explanation

Correct (2): TACO — circulatory overload from rapid/large-volume transfusion, especially in elderly/CHF/CKD. Signs: dyspnea, JVD, HTN, crackles, S3, rising BNP. Management: slow/stop transfusion, sit upright, O2, IV furosemide. Prevention: pre-transfusion diuretic, slower rate. TRALI differs — hypotension + non-cardiogenic pulmonary edema within 6 hours; treat with respiratory support. (1) TRALI has hypotension. (3) Anaphylaxis = hives + wheeze. (4) Septic = chills + fever shock.

## In-depth explanation

Memory Tip TACO = "Too much volume — HYPERtension + JVD + responds to diuretic." TRALI = "Lung damage — HYPOtension + bilateral infiltrates + needs respiratory support." Both within 6 hours but TACO is hypervolemia, TRALI is non-cardiogenic edema.

## Clinical scenario

Scenario 82-year-old female CHF receiving 2 units PRBC; 90 min into infusion: acute dyspnea, JVD, BP 178/96, crackles, BNP rising.

## Key concepts

- **TACO** — Transfusion-associated circulatory overload; hypervolemia; respond to diuretic.
- **TRALI** — Transfusion-related acute lung injury; non-cardiogenic edema; hypotension; respiratory support.
- **Transfusion reaction differentiation** — Distinguish TACO (HTN/JVD/diuresis works) from TRALI (HypoTN/non-cardiogenic).

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