Incidence and clinical characteristics of transfusion‐associated circulatory overload using an active surveillance algorithm

Abstract

Background The concordance of hemovigilance criteria developed for surveillance of transfusion-associated circulatory overload (TACO) with its clinical diagnosis has not been assessed. In a pilot study to evaluate an electronic screening algorithm, we sought to examine TACO incidence and application of hemovigilance criteria in patients with post-transfusion pulmonary edema. Study Design and Methods From June to September 2014, all transfused adult inpatients at four academic hospitals were screened with an algorithm identifying chest radiographs ordered within 12 hours of blood component release. Patients with post-transfusion pulmonary edema underwent case adjudication by an expert panel. TACO incidence was calculated and clinical characteristics were compared with other causes of post-transfusion pulmonary edema. Results Among 4,932 transfused patients, there were 3,412 algorithm alerts, 50 cases of TACO and 47 other causes of pulmonary edema. TACO incidence was 1 case per 100 patients transfused. TACO classification based on two sets of hemovigilance criteria (National Healthcare Safety Network and proposed revised International Society for Blood Transfusion) was concordant with expert panel diagnosis in 57% and 54% of reviewed cases, respectively. Although, the majority of clinical parameters did not differentiate expert-panel adjudicated TACO from other cases, improved oxygenation within 24 hours of transfusion did (p=.01). Conclusions The incidence of TACO was similar to that observed in prior studies utilizing active surveillance. Case classification by hemovigilance criteria was frequently discordant with clinical diagnoses of TACO in patients with post-transfusion pulmonary edema. Improvements in oxygenation within 24 hours of transfusion merit further evaluation in the diagnosis of TACO.

Transfusion‐associated circulatory overload—a systematic review of diagnostic biomarkers

“…Our review has limitations: The biomarker test characteristics have been analyzed as stand‐alone biomarkers for disease. However, TACO is a clinical diagnosis, and the diagnostic value, when combined with clinical signs and symptoms, has proven better sensitivity and specificity in a number of the studies . An ideal biomarker for TACO should be present only in disease and correlate with severity of pulmonary edema.…”

Transfusion‐associated circulatory overload in ambulatory patients

“…These estimates are from peri‐operative cohorts, medical emergency units, inpatients at tertiary care facilities and haemovigilance registries. The reported incidence varies depending on whether active or passive surveillance techniques are employed, with active surveillance resulting in higher estimates .…”

Transfusion‐associated circulatory overload prevention: a retrospective observational study of diuretic use

“…Transfusion‐associated circulatory overload (TACO) is one of the leading causes of transfusion‐associated mortality . Its prevalence varies depending on the type of reporting and the patient population, with estimates ranging from 1 in 5932 components transfused to 1 in 28 873 components issued in passive haemovigilance systems to 1–11% of transfused patients with active reporting . Significant morbidity has been described with up to 18% requiring transfer to intensive care .…”