Transfusion medicine
Transfusion side effects
Transfusion associated circulatory overload (TACO)

Author: Huy Phu Pham, M.D. (see Authors page)

Revised: 15 November 2017, last major update September 2011

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Transfusion associated circulatory overload [title]

Cite this page: Pham, H.P. Transfusion associated circulatory overload (TACO). PathologyOutlines.com website. http://pathologyoutlines.com/topic/transfusionmedcirculatoryoverload.html. Accessed November 18th, 2017.
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
Pathophysiology
  • Inability of the patient's cardiopulmonary system to handle the transfused volume or the transfusion rate
  • Causes cardiogenic pulmonary edema
Diagnosis
Physical exam:
  • Lung crackles and rales, elevated jugular venous pressure
Laboratory
  • 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
Incidence
  • 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
Prevention
  • 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
  • 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