Transfusion Associated Circulatory Overload (TACO) Incidence and Risk Factors.

Abstract

3157 Poster Board III-94 Introduction Transfusion circulatory overload (TACO) is a complication of transfusion, often confused with transfusion acute lung injury (TRALI), and is probably under-reported. The pathophysiology is believed to be caused by increased hydrostatic blood pressure leading to fluid leakage in the alveolar space, emulating congestive cardiac failure. We report on a large cohort of TACO cases in Ireland. Methods All consecutive TACO cases reported to the National Haemovigilance Office of Ireland between 2000-2008 were retrospectively reviewed. The incidence of TACO was calculated on units issued from the Irish Blood Transfusion Service (IBTS). Comparative analysis of patient demographic and clinical data was made using Fisher's exact test. Results 179 TACO cases were reviewed. 149 (83%) involved red cell concentrate (RCC), platelets (PLT) n=4 (2%); fresh frozen plasma (FFP) /solvent detergent plasma (SDP) n=16 (8%); multiple components n=10 (6%). During the study period, a total 1,614,973 blood components (RCC, FFP, SDP and PLT) were issued corresponding to a TACO incidence of 1/10.000 of all components issued. TACO incidence per RCC, platelets and plasma issued was 1/8000, 1/48000 and 1/15000 respectively, excluding the cases where multiple components were transfused. While the majority of patients developing TACO were elderly (> 70years)(n= 120, 67%), up to eight cases (4%) were reported in young patients (<30 years). There was no difference in gender. An underlying cardiovascular condition was reported in 73% (131) cases. Patient outcome was specified in 178 cases. One hundred and fifty three (85%) patients recovered post reaction. However, 15 (8%) patients experienced morbidity ranging from prolonged resolution of symptoms, to myocardial infarction (n=2), cancellation of surgery (n=1), and admission to intensive care (n=4). 25 (14%) deaths were reported, and TACO was identified as possible cause of death in n=5 (2%) cases. Four of these patients were male and one patient was female. A total of 158 (88%) patients received diuretics before (n=36), during (n=26) or post (n=124). Nineteen patients (11%) did not receive diuretics; four of these patients died, one of which was possibly attributed to transfusion. Information was unavailable in two cases. Patients treated with diuretics post transfusion were more likely to survive (80% vs. 40%); however statistical significance was not reached (p=0.07). The median transfused volume was 275 mls (range 80-9500 mls). There was no statistical significance between actual time of transfusion and time over which transfusion were prescribed. Approximately 10 % (18) cases involved large volume transfusion most likely in an emergency situation. While only three of these transfusion events met the clinical definition of a massive transfusion (150mls per minute), patients in this cohort received between 300 and 8200 mls per hour. The median volume transfused was 1500mls (range 1000mls – 9500mls). Eleven (61%) patients had underlying cardiovascular conditions. Seven patients were > 70 years, all of whom had underlying cardio–vascular conditions. Four (22%) patients died, one death which was possibly attributed to transfusion, and a further three patients (17%) required admission to intensive care. Four (22%) cases involved young female patients (age < 30 years) who had no underlying cardiovascular condition, but one patient had asthma. These patients were being treated for obstetric bleeding, and all recovered. Conclusion This study reports a TACO incidence of 1 /10 000 units issued from the IBTS. Although this incidence is based on units issued rather than transfused, it probably reflects significant underreporting, and perhaps even under-recognition. This study identified TACO has significant impact on patient outcome with approximately 8% (15) of patients suffering significant morbidity and a further 2% (5) of patients dying following onset of TACO. Finally, patients receiving large volume transfusion in emergency situations even young patients are at risk of developing TACO. Disclosures No relevant conflicts of interest to declare.

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

“…Pretransfusion diuretic therapy was not found to be protective. This is similar to the findings of Andrea et al 21 . where 40% of patients received diuretics but still progressed to TACO.…”

“…Our previous study noted a higher rate of TACO (1 in 356) than TRALI (1 in 534) per unit of blood component transfused 3 . This is much higher than the incidence rate in a recent hemovigilance report from Ireland (1/10,000 of all components) 21 . In addition to a different study population (critically ill patients vs. all transfused patients), the major difference is likely a result of different identification methods (prospective observation vs. passive reporting).…”

“…In contrast, the median age of our TACO patients was 73 years, similar to recent reports from Robillard et al 23 . and Andrea et al 21 . This difference is explained by the differing study populations because patients undergoing total hip or knee replacements are more likely to be of advanced age than an unselected ICU population.…”

“…Left ventricular dysfunction is believed to be a risk factor for TACO with previous estimates reporting its presence in 73% (131) of TACO cases 21 . TACO often occurs in elderly patients 6 and those with compromised cardiac function 24 .…”

Complications of Blood Transfusion

“…Transfusion-associated circulatory overload (TACO) is the most common type of transfusion-related pulmonary complication with an estimated incidence estimate of 1–8% (although some estimating it to be as high as 11%) [ 11 ]. TACO was first observed in the 1930s, but became recognized as a distinct clinical entity in the 1990s [ 12 ]. The incidence of TACO varies by study, with data from passive surveillance showing a very low incidence while studies with active surveillance reporting a higher incidence.…”