Transfusion associated circulatory overload (TACO) may occur when excessive volumes of blood or components are administered too quickly. This complication occurs most frequently in patients with severe chronic anemia because they have an expanded blood volume. Infants, elderly adults, and patients with heart or kidney disease are also more prone to develop circulatory overload. When too much blood is transfused too quickly, these patients cannot handle the volume increase and consequently develop heart failure and acute pulmonary edema.

Symptoms: Symptoms include dyspnea, orthopnea, wheezing, tightness in the chest, dry cough, headache, cyanosis, tachypnea, and rapid increase in blood pressure. Peripheral and pulmonary edema may also develop.

Consequences: Usually not serious if intervening steps are taken. Potentially life-threatening if not promptly recognized.

Lab Data: No evidence of serological incompatibility.

Treatment:

At the first indication, the patient is placed in a sitting position and the transfusion is stopped. If symptoms progress oxygen support and IV administration of a rapid acting diuretic may be necessary. If symptoms are severe and urgent, a therapeutic phlebotomy of 200 to 400 mL may be warranted.

Prevention: Prevention includes avoiding unnecessary fluids, using concentrated components and not transfusing more than 2 units per day. For very unstable patients, it may be necessary to split a unit into two aliqouts and transfuse one half of a unit very slowly at a flow rate not exceeding 1 mL/kg of body weight per hour. Diuretics can also be given prior to transfusion.

Last Updated on Wednesday, 13 July 2011