Transfusion medicine
Transfusion reactions & complications
Circulatory overload

Topic Completed: 1 September 2011

Minor changes: 12 April 2021

Copyright: 2002-2021,, Inc.

PubMed Search: Transfusion associated circulatory overload [title]

Huy Phu Pham, M.D., M.P.H.
Page views in 2020: 353
Page views in 2021 to date: 328
Cite this page: Pham H. Circulatory overload. website. Accessed April 19th, 2021.
Definition / general
  • 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
  • Inability of the patient's cardiopulmonary system to handle the transfused volume or the transfusion rate
  • Causes cardiogenic pulmonary edema
Physical exam:
  • Lung crackles and rales, elevated jugular venous pressure
  • Increased brain natriuretic peptide (BNP) is 81% sensitive and 89% specific (Transfusion 2005;45:1056)
  • CXR: alveolar and interstitial edema, distended pulmonary artery, cardiomegaly
Differential diagnosis
  • 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
Clinical manifestation
  • 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
  • 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
  • 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
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