Incidence and transfusion risk factors for transfusion‐associated circulatory overload among medical intensive care unit patients

Abstract

BACKGROUND-Transfusion-associated circulatory overload (TACO) is a frequent complication of blood transfusion. Investigations identifying risk factors for TACO in critically ill patients are lacking.

Storage of Red Blood Cells and Transfusion-Related Acute Lung Injury

“…Most clinical studies of TRALI have been conducted in operating rooms and ICU, in the form of prospective and retrospective case-control data analyses in critically ill patients in many different settings (Table 2) [3][4][5][17][18][19]21,23,25,26]. Koch et al [27] have primarily examined the effects of transfusion on cardiac patients, observing significant increase in respiratory insufficiency and necessity for mechanical ventilation after transfusion of older RBC units [3,27].…”

“…Such large range in incidence could be attributed to the relatively unspecific diagnostics tools available for TRALI, past cases of under-diagnosis or misdiagnosis, and the elevated incidence of TRALI within vulnerable populations [14][15][16]. A recent study analyzing the incidence of TRALI in critically ill patients admitted to intensive care unit (ICU) observed that over 5% of all patients who received blood transfusion developed TRALI, which is 50-100 times greater occurrence than in the general hospital population [12,17]. …”

Continuous spinal anesthesia for Cesarean hysterectomy and massive hemorrhage in a parturient with placenta increta

“…Differentiating these two conditions can be difficult. The occurrence of TACO has been linked specifically with the rate and volume of plasma transfused, 24 whereas TRALI has been defined as acute lung injury occurring within six hours of transfusion (or up to 72 hr if delayed TRALI), which is not related to other risk factors for acute lung injury or adult respiratory distress syndrome (ARDS). 25 Transfusion-related acute lung injury is a phenomenon of increased permeability, whereas TACO is hydrostatic pulmonary edema, a pressure-related phenomenon.…”

Anemia, Bleeding, and Blood Transfusion in the Intensive Care Unit: Causes, Risks, Costs, and New Strategies

“…These patients, on average, received multiple units of plasma (mean, 4.0 units; SD, 2.3 units) before TACO developed. 89 In a 2-year prospective cohort study 90 of 901 ICU patients, researchers reported that TACO developed in 6% of patients who received a transfusion. Significant risk factors were left ventricular dysfunction and transfusion of fresh frozen plasma to treat overuse of anticoagulants.…”

“…Significant risk factors were left ventricular dysfunction and transfusion of fresh frozen plasma to treat overuse of anticoagulants. 90 Signs and symptoms of TACO may include lung crackles and rales, elevated jugular venous pressure, dyspnea, orthopnea, wheezing, tightness in the chest, cough, cyanosis, tachypnea, a rapid increase in blood pressure, and distended neck veins. Because TACO has many of the same signs and symptoms as TRALI, the 2 conditions can be difficult to distinguish and in fact may coexist in a patient.…”