Transfusion-Associated Circulatory Overload (TACO) and Other Transfusion Reactions

Definition and Characteristics of TACO

Transfusion-associated circulatory overload (TACO) is characterized by acute or worsening respiratory compromise and/or pulmonary edema during or up to 12 hours after transfusion, cardiovascular changes including tachycardia and hypertension, evidence of fluid overload, and supportive biomarker results such as elevated brain natriuretic peptide, according to the American Society of Anesthesiologists 1
The American College of Surgeons recommends that TACO be recognized as the most common cause of transfusion-related mortality and major morbidity 1

Older, non-bleeding patients (age >70 years) are at increased risk of developing TACO, as stated by the American Geriatrics Society 1
Pre-existing comorbidities, including heart failure, renal failure, and hypoalbuminemia, increase the risk of TACO, according to the American Heart Association 1
Low body weight and rapid transfusion rate also increase the risk of TACO, as recommended by the American Society of Anesthesiologists 1

Febrile non-hemolytic transfusion reactions are more commonly associated with red blood cell units and present with fever and chills, according to the American Association of Blood Banks 2
Allergic reactions are more commonly associated with plasma and platelets, and present with urticaria and pruritus, as stated by the American Academy of Allergy, Asthma, and Immunology 2
Bacterial contamination most frequently affects platelets due to room temperature storage, representing the most frequent infectious complication from blood products, according to the Centers for Disease Control and Prevention 4, 5

The American Society of Anesthesiologists recommends carefully assessing the need for transfusion in high-risk patients, using body weight dosing of red blood cells, implementing slow transfusion rates, monitoring vital signs and fluid balance closely, and considering prophylactic diuretic administration in high-risk patients to reduce the risk of TACO 1

The American Society of Anesthesiologists recommends monitoring respiratory rate throughout transfusion, recording observations including pulse, blood pressure, and temperature before, during, and after each unit transfused, checking for signs of bacterial contamination, TRALI, and hemolytic reactions, assessing urine output and color, and monitoring peak airway pressure in ventilated patients 1, 4

The American Red Cross recommends ensuring proper patient identification to prevent ABO incompatibility, maintaining appropriate storage conditions for blood products, having protocols in place for managing transfusion reactions, and reporting adverse reactions to hemovigilance systems when administering blood products 1, 2, 3, 5