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Transfusion medicine

Tranfusion side effects

Transfusion associated circulatory overload (TACO)


Reviewer: Huy Phu Pham, M.D. (see Reviewers page)
Revised: 1 November 2011, last major update September 2011
Copyright: (c) 2007-2011, PathologyOutlines.com, Inc.

General
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● Due to circulatory overload following transfusion; specifically the inability of the recipient to compensate for the volume of the product transfused
● Other causes: impaired cardiac function, rapid rate of transfusion

Incidence
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● Common transfusion reaction - 1 per 2,000 red cell transfusions or 1 per 400 red cell transfusions in ICU (Transfusion 2006;46:1478)
● 1% of elderly patients with total knee or hip replacement (Immunohematol 1996;12:87)
● 1 per 6,000 platelet pool recipients
● May occur only after 1–2 pRBC units

Pathophysiology
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● Inability of the patient’s cardiopulmonary system to handle the transfused volume or the transfusion rate
● Causes cardiogenic pulmonary edema

Clinical manifestation
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● Usually occurs at end of transfusion; may occur up to 6 hours after its completion
● Dyspnea, orthopnea, tachycardia, hypertension, increased venous pressure, congestive heart failure

Diagnosis
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Physical exam:
● Lung crackles and rales, elevated jugular venous pressure

Laboratory
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● Increased brain natriuretic peptide (BNP) is 81% sensitive and 89% specific (Transfusion 2005;45:1056)
● CXR: alveolar and interstitial edema, distended pulmonary artery, cardiomegaly

Prevention
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● Identify patients at risk, and transfuse at slower rate
● May need to split the product in halves, and infuse each aliquot over 4 hours
● Patients at risk: compromised cardiovascular function, current volume overload, small intravascular volume (elderly, young children), severe chronic anemia

Management
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● Stop the transfusion if patient develops respiratory distress
● Report the transfusion reaction to the blood bank for investigation
● Treat with diuretics; supportive management, such as oxygen, can also be given

Case reports
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● 84 year old man with respiratory distress after receiving fresh frozen plasma (University of Pittsburgh)

Differential diagnosis
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● TRALI: usually no cardiovascular history, but difficult to distinguish in critically ill patients (Crit Care Med 2006;34:S109)
● Anaphylaxis
● Bacterial contamination
● ALWAYS need to rule out hemolytic transfusion reaction

End of Transfusion Medicine > Tranfusion side effects > Transfusion associated circulatory overload (TACO)


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