Contemporary Risk Factors and Outcomes of Transfusion-Associated Circulatory Overload*

Abstract

Despite restrictive transfusion practice, transfusion-associated circulatory overload remains a frequent complication of transfusion and is an independent risk factor for in-hospital morbidity and mortality. In addition to cardiovascular and renal risk factors, plasma transfusion was associated with transfusion-associated circulatory overload after controlling for other covariates. Additional research is needed to examine the benefit of reduced erythrocyte or plasma exposure in patients at high risk for transfusion-associated circulatory overload.

Volume incompliance and transfusion are essential for transfusion‐associated circulatory overload: a novel animal model

“…Observational studies showed that AKI and cardiac failure are risk factors for the development of TACO . We confirmed that these underlying conditions result in a decreased volume compliance, which is essential for the development of TACO in our animal model.…”

“…In a nationwide hemovigilance study, up to 50% of TACO cases occurred after transfusion of a single blood product . Moreover, the incidence of TACO differs between transfusion products, an effect that cannot be explained solely by the infusion of volume. Previous studies in otherwise healthy animals as well as human volunteers show that even massive and rapid infusion of crystalloids (30 mL/kg at 100 mL/min) does not result in cardiac overload.…”

“…We hypothesized that volume incompliance through a “first hit” is required for TACO to develop, lowering the threshold for a blood transfusion to cause circulatory overload. Risk factors that are strongly associated with the development of TACO include renal and cardiac failure which limit hemodynamic accommodation to volume challenges. Furthermore, observational studies showed that pretransfusion volume status is important, and particularly circulatory overload seems to occur in normovolemic transfused patients …”

The Pathogenic Involvement of Neutrophils in Acute Respiratory Distress Syndrome and Transfusion-Related Acute Lung Injury

“…Cardiac failure was recently identified as a major risk factor for TACO in a retrospective cohort study of 66 TACO patients [70]. Also another prospective study of 200 TACO patients found congestive heart failure to be one of the risk factors associated with TACO [71]. Similarly, a previous study also retrospectively identified congestive heart failure as risk factor for TACO in 98 TACO cases [72].…”

Transfusion‐associated circulatory overload risk mitigation: survey on hospital policies for compliance with AABB Standard 5.9.17

“…In the United States, TACO was the leading cause of transfusion‐related mortality reported to the Food and Drug Administration in 2016 . The patients who are especially at risk of TACO include those with underlying congestive heart failure, chronic pulmonary disease, older age, receipt of continuous venovenous hemodialysis, and acute kidney injury and those receiving a large number of blood components …”