Transfusion-Associated Circulatory Overload: A Clinical Perspective

Transfus Med Rev. 2019 Apr;33(2):69-77. doi: 10.1016/j.tmrv.2019.01.003. Epub 2019 Feb 7.

Abstract

For 30 years, transfusion-associated circulatory overload (TACO) has been recognized as a serious transfusion complication. Currently, TACO is the leading cause of transfusion-related morbidity and mortality worldwide which occurs in 1% to 12% of at-risk populations. Despite an incomplete understanding of the underlying pathophysiology, TACO is defined as a collection of signs and symptoms of acute pulmonary edema due to circulatory overload occurring within 6 to 12 hours of transfusion. In the past decade, large observational cohort studies resulted in better insight into the associated transfusion risk factors leading to the development of TACO. In this clinical review, we critically analyze the pathogenesis of TACO, associated risk factors, clinical presentation, diagnostic modalities, and treatment options to guide clinicians with early detection of this syndrome and intervention to improve clinical outcomes. Future research should focus on better understanding of the pathogenesis to help advance the field of volume kinetics and endothelial barrier function.

Keywords: Critical care; Hematology; Hemovigilance; Transfusion; Volume overload.

Publication types

  • Systematic Review

MeSH terms

  • Algorithms
  • Biomarkers
  • Blood Transfusion
  • Databases, Factual
  • Erythrocyte Transfusion / adverse effects*
  • Hospital Mortality
  • Humans
  • Patient Compliance
  • Proportional Hazards Models
  • Pulmonary Edema / prevention & control
  • Risk Factors
  • Transfusion Reaction / diagnosis*
  • Transfusion Reaction / physiopathology
  • Transfusion Reaction / therapy*
  • Treatment Outcome

Substances

  • Biomarkers