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

Abstract

T ransfusion-associated circulatory overload (TACO) is the largest cause of transfusion-related major morbidity and mortality. 1-3 Current understanding of TACO is that volume overload occurs, specifically ABBREVIATIONS: AKI = acute kidney injury; BALF = bronchoalveolar lavage fluid; COP = colloid osmotic pressure; CVP = central venous pressure; ECV = estimated circulating volume; KDA = ketamine-dexmedetomidine-atropine solution; LVEDP = left ventricular end-diastolic pressure; MAP = mean arterial pressure; MI = myocardial infarction; PV = pressure-volume (catheter); PCWP = pulmonary capillary wedge pressure; RL = Ringer's lactate; TACO = transfusion-associated circulatory overload; WD = pulmonary wet weight/dry weight (ratio).From the

Plasma as a resuscitation fluid for volume‐depleted shock: Potential benefits and risks

“…In contrast to TRALI, the pathophysiology underlying the lung edema of TACO is hydrostatic in nature. Risk factors are patient conditions associated with an impaired ability to handle fluid loading of a blood product, including cardiac or renal disease 103 . Thereby, TACO can occur following volume loading due to any blood product, and does not pertain to plasma in particular.…”

“…Risk factors are patient conditions associated with an impaired ability to handle fluid loading of a blood product, including cardiac or renal disease. 103 Thereby, TACO can occur following volume loading due to any blood product, and does not pertain to plasma in particular. Also, in resuscitation of shock, expanding the circulating volume is a wanted intervention.…”

Transfusion in the mechanically ventilated patient

“…In contrast to ARDS and TRALI, the pathophysiology underlying the lung edema of TACO is hydrostatic in nature [ 28 – 30 ]. Risk factors are conditions associated with an impaired ability to handle fluid loading with a blood product, including cardiac or renal disease [ 31 ]. However, in addition to volume, other aspects of the transfused blood component may also play a role [ 28 ].…”

Clinical Usefulness of Furosemide to Prevent Volume Overload Among Children and Young Adults with Transfusion-Dependent Thalassemia: A Randomized, Open-Label, Crossover Study

“…Although the pathophysiology of this condition has been unclear, inappropriate management of patient's volume status, preexisting cardiac and/or renal dysfunctions, numbers of red blood cell product transfused and an extreme of age are associated with increased risk of TACO. [11][12][13] HCC syndrome is a transfusion-related complication and can be found among patients with thalassemia requiring either occasional, regular or frequent transfusion regimens. [14][15][16][17][18][19][20][21] The syndrome has been found to be associated with prolonged chronic anemia; however, posttransfusion hypertension is more common and can be found in 16.7% of patients with beta thalassemia 22 in which some patients reported headaches or even developed seizures.…”