1. Emergency physicians should maintain a high level of suspicion for transfusion related acute lung injury (TRALI) in patients with respiratory symptoms that occur within 6 hours of a transfusion and anticipate the need for endotracheal intubation and critical care.

2. In patients already intubated for other conditions (such as trauma or compromised airway), TRALI can be detected if a sudden drop in oxygenation follows a blood transfusion.

3. Although TRALI is rare and declining in incidence due to prevention strategies, incidence can be as high as 8% in populations receiving multiple transfusions, such as oncologic patients.

4. TRALI can be distinguished from transfusion associated circulatory overload (TACO) by stable natriuretic peptide levels and no risk factors for fluid overload such as cardiomyopathy or renal insufficiency. Avoid diuretics as they may precipitate hypotension.

5. Suspected transfusion reactions must always be reported to the Blood bank for initiation of appropriate work up and donor tracing.