What harmful effect can occur from the rapid transfusion of packed red blood cells (PRBCs)?

The rapid transfusion of packed red blood cells (PRBCs) can lead to transfusion-related acute lung injury (TRALI), which is a serious complication characterized by acute respiratory distress that occurs within six hours of transfusion. TRALI is believed to be caused by the interaction of donor antibodies with recipient leukocytes, resulting in an inflammatory response in the lungs, leading to pulmonary edema, hypoxemia, and potentially impaired gas exchange.

The pathophysiology involves the activation of the immune system, which can cause damage to the pulmonary capillaries and increase permeability, leading to fluid accumulation in the alveolar spaces. This condition requires prompt recognition and intervention, as it can significantly compromise oxygenation and respiratory function.

In contrast, while options like hypothermia, transfusion-associated circulatory overload (TACO), and increased risk of infection are legitimate concerns with blood transfusions, they represent different mechanisms and risks associated with the rapid administration of PRBCs. Hypothermia may occur due to the cool temperature of stored blood products, TACO relates to volume overload particularly in patients with heart issues, and the risk of infection is generally linked to blood product contamination over time rather than the immediate rapid transfusion itself.