Transfusion-associated circulatory overload

Medical condition related to blood transfusion

Transfusion-associated circulatory overload (TACO) is a serious complication that can occur following a blood transfusion. It is characterized by an excess of fluid in the circulatory system, leading to symptoms of heart failure and pulmonary edema. TACO is a significant cause of transfusion-related morbidity and mortality, particularly in vulnerable populations such as the elderly and those with pre-existing cardiac conditions.

Pathophysiology

TACO occurs when the volume of transfused blood products exceeds the recipient's cardiovascular capacity to handle the additional fluid load. This can result in increased venous pressure, leading to fluid accumulation in the lungs and peripheral tissues. The condition is often exacerbated by rapid transfusion rates and large transfusion volumes.

Pulmonary edema as seen in TACO

Clinical Presentation

Patients with TACO typically present with symptoms of acute dyspnea, tachycardia, hypertension, and hypoxemia. Physical examination may reveal signs of jugular venous distension, rales on lung auscultation, and peripheral edema.

Leg edema, a common symptom of TACO

Diagnosis

The diagnosis of TACO is primarily clinical, based on the temporal relationship between blood transfusion and the onset of symptoms. Diagnostic criteria include:

• Acute respiratory distress within 6 hours of transfusion
• Evidence of fluid overload
• Elevated brain natriuretic peptide (BNP) levels
• Radiographic evidence of pulmonary edema

Management

The management of TACO involves supportive care and measures to reduce fluid overload. Key interventions include:

• Stopping the transfusion immediately
• Administering diuretics to promote fluid excretion
• Providing supplemental oxygen therapy
• In severe cases, mechanical ventilation may be required

Nasal prongs for oxygen therapy

Prevention

Preventive strategies for TACO focus on careful assessment of the patient's fluid status and transfusion needs. Recommendations include:

• Using the smallest effective volume of blood products
• Slowing the rate of transfusion
• Monitoring patients closely during and after transfusion, especially those at high risk

Epidemiology

TACO is one of the most common causes of transfusion-related adverse events. It is more prevalent in older adults, patients with chronic kidney disease, and those with underlying cardiac dysfunction. The incidence of TACO varies, but it is estimated to occur in 1-8% of transfusions.

Related pages

• Blood transfusion
• Pulmonary edema
• Heart failure
• Transfusion reaction

Blood transfusion process