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Transfusion-associated circulatory overload

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Transfusion associated circulatory overload
Other namesTACO[1]
Peripheral edema in the lower extremity that can result from volume overload following large volume blood transfusions.
SpecialtyHematology
Symptomsdyspnea, orthopnea, peripheral edema, hypertension.
Usual onsetWithin 12 hours of transfusion

In transfusion medicine, transfusion associated circulatory overload (aka TACO) is a transfusion reaction (an adverse effect of blood transfusion) resulting in signs or symptoms of hypervolemia within 12 hours after transfusion.[2] It can occur due to a rapid transfusion of a large volume of blood but can also occur during a single red cell transfusion (about 15% of cases).[2] It is often confused with transfusion-related acute

Symptoms and signs

The primary symptoms of TACO are dyspnea, orthopnea, peripheral edema, and rapid increase of blood pressure.[3] TACO must be suspected when there is respiratory distress with other signs, including pulmonary edema, unanticipated cardiovascular system changes, and evidence of fluid overload (including improvement after diuretic, morphine or nitrate treatment), during or up to 24 hours after transfusion.[2]

Risk factors

Diagnosis

The National Healthcare Safety Safety Network division of the Centers for Disease Control and Prevention (CDC) released an updated criteria table in 2021.[7]

Patients diagnosed with TACO should have at least 1 of the following characteristics within 12 hours after the transfusion was ended:

A chest x-ray showing pulmonary edema with bilateral pleural effusions.

Along with:

Classification

TACO can be categorized by severity[7]:

  • Non-severe - where no permanent damage would arise if treatment was not given. However, treatment is still needed.
  • Severe - where the patient either requires hospitalization as a result or, if already hospitalized, has an extended length of stay as a result. Treatment is needed to avoid permanent damage.
  • Life threatening - where intensive care such as vasopressor agents and mechanical ventilation is required in order to prevent death.
  • Death

Differential diagnosis

TACO and transfusion-related acute lung injury (TRALI) are both complications following a transfusion, and both can result in respiratory distress.[2] TACO and TRALI are often difficult to distinguish in the acute situation.

Assessing fluid status is key in differentiating between the two. In TACO, the patient will always have a positive fluid balance and will often present with hypertension, jugular venous distension, elevated BNP, peripheral edema, and will respond well to diuretics. In contrast , TRALI is not associated with fluid overload and the patient may have a positive, even, or net fluid balance. Patients with TRALI often present with hypotension, no signs of right-heart fluid overload, normal BNP, and lack of clinical improvement in response to diuretics.[8][9][5]

Prevention

Transfusion associated circulatory overload is prevented by avoiding unnecessary transfusions, closely monitoring patients receiving transfusions, transfusing smaller volumes of blood at a slower rate, and considering the use of furosemide as a diuretic.[2][3][10] A pre-transfusion TACO checklist can be used to assess patients' risk of developing TACO.[2][4]

Management

If TACO is suspected, the transfusion is stopped immediately and the person is treated with oxygen, diuretics, and other treatments for heart failure.[citation needed]

Occurrence

It is difficult to determine the incidence of TACO, but its incidence is estimated at about one in every 100 transfusions using active surveillance,[11][12] and in one in every 10000 transfusions using passive surveillance.[11] TACO is the most commonly reported cause of transfusion-related death and major morbidity in the UK,[2] and second most common cause in the USA.[13]

The risk increases with patients over the age of 60, patients with cardiac or pulmonary failure, renal impairment, hypoalbuminemia or anemia. [3][2]

References

  1. ^ Agnihotri, Naveen; Agnihotri, Ajju (2014). "Transfusion associated circulatory overload". Indian Journal of Critical Care Medicine. 18 (6): 396–398. doi:10.4103/0972-5229.133938. PMC 4071685. PMID 24987240.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  2. ^ a b c d e f g h Bolton-Maggs, Paula (Ed); Poles, D; et al, on behalf of the Serious Hazards of Transfusion (SHOT) Steering Group (2017). The 2016 Annual SHOT Report (2017) (PDF). Serious Hazards of Transfusion (SHOT). ISBN 978-0-9558648-9-6.
  3. ^ a b c Noninfectious Adverse Events of Transfusion - Transfusion Transmitted Injuries Section - Blood Safety Surveillance and Health Care Acquired Infections Division - Public Health... Archived 2008-06-20 at the Wayback Machine
  4. ^ a b c Bolton-Maggs, PHB; Poles, D, eds. (2018). "The 2017 Annual SHOT Report (2018)" (PDF). {{cite journal}}: Cite journal requires |journal= (help)
  5. ^ a b c d e "Transfusion-associated circulatory overload (TACO)(2018)" (PDF). ISBT. Retrieved 24 June 2019.
  6. ^ a b Clifford, Leanne; Jia, Qing; Subramanian, Arun; Yadav, Hemang; Schroeder, Darrell R.; Kor, Daryl J. (March 2017). "Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload". Anesthesiology. 126 (3): 409–418. doi:10.1097/ALN.0000000000001506. PMC 5309147. PMID 28072601.
  7. ^ a b Centers for Disease Control and Prevention (March 2021). "National Healthcare Safety Network Biovigilance Component Hemovigilance Module Surveillance Protocol" (PDF). N/A. 2.6: 9.
  8. ^ Popovsky, M. A. (September 2006). "Transfusion-related acute lung injury and transfusion-associated circulatory overload". ISBT Science Series. 1 (1): 107–111. doi:10.1111/j.1751-2824.2006.00046.x.
  9. ^ Skeate, Robert C; Eastlund, Ted (November 2007). "Distinguishing between transfusion related acute lung injury and transfusion associated circulatory overload". Current Opinion in Hematology. 14 (6): 682–687. doi:10.1097/MOH.0b013e3282ef195a. PMID 17898575.
  10. ^ Alam, Asim; Lin, Yulia; Lima, Ana; Hansen, Mark; Callum, Jeannie L. (April 2013). "The prevention of transfusion-associated circulatory overload". Transfusion Medicine Reviews. 27 (2): 105–112. doi:10.1016/j.tmrv.2013.02.001. ISSN 1532-9496. PMID 23465703.
  11. ^ a b Raval, J. S.; Mazepa, M. A.; Russell, S. L.; Immel, C. C.; Whinna, H. C.; Park, Y. A. (May 2015). "Passive reporting greatly underestimates the rate of transfusion-associated circulatory overload after platelet transfusion". Vox Sanguinis. 108 (4): 387–392. doi:10.1111/vox.12234. PMID 25753261.
  12. ^ Clifford, Leanne; Jia, Qing; Yadav, Hemang; Subramanian, Arun; Wilson, Gregory A.; Murphy, Sean P.; Pathak, Jyotishman; Schroeder, Darrell R.; Ereth, Mark H.; Kor, Daryl J. (January 2015). "Characterizing the Epidemiology of Perioperative Transfusion-associated Circulatory Overload". Anesthesiology. 122 (1): 21–28. doi:10.1097/ALN.0000000000000513. PMC 4857710. PMID 25611653.
  13. ^ "Fatalities Reported to FDA Following Blood Collection and Transfusion Annual Summary for Fiscal Year 2015". FDA. Retrieved July 17, 2017.
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