What is the most frequent major complication of blood transfusion, such as volume overload, hemolytic reaction, Human Immunodeficiency Virus (HIV) infection, Hepatitis C, or Hepatitis B?

From the Guidelines

The most frequent major complication of blood transfusion is volume overload, specifically Transfusion-associated circulatory overload (TACO) (option a). This complication is now the most common cause of transfusion-related mortality and major morbidity 1. Volume overload occurs when the cardiovascular system cannot accommodate the additional fluid volume from transfused blood products, particularly in patients with pre-existing cardiac or renal dysfunction. Key risk factors for developing TACO include older age (over 70 years), comorbidities such as heart failure, renal failure, and hypoalbuminaemia, low body weight, and rapid transfusion 1.

Identifying and Managing TACO

To identify TACO, it is essential to monitor patients closely during and after transfusion, with particular attention to respiratory rate, as dyspnea and tachypnea are typical early symptoms of serious transfusion reactions 1. Other vital signs such as pulse, blood pressure, and temperature should also be monitored and documented for each unit transfused.

Prevention Strategies

Prevention of volume overload involves careful assessment of the patient's fluid status before transfusion, consideration of diuretic administration when appropriate, and transfusing blood products at appropriate rates, particularly in high-risk patients. By prioritizing these preventive measures and being vigilant for the signs of TACO, clinicians can significantly reduce the risk of this major complication. While other complications like hemolytic reactions, hepatitis B, hepatitis C, and HIV transmission are serious, they are less frequent due to advancements in cross-matching techniques and rigorous blood screening protocols 1.

From the Research

Major Complications of Blood Transfusion

The most frequent major complication of blood transfusion is:

• Volume overload, also known as transfusion-associated circulatory overload (TACO) 2, 3, 4, 5

Characteristics of TACO

Some key characteristics of TACO include:

• It is a common yet underrecognized and underreported complication of transfusion associated with significant morbidity and mortality 2
• It is characterized by hydrostatic pulmonary edema following blood transfusion 3
• The incidence of TACO is one case per 100 transfused patients 3
• It occurs in 1% to 12% of at-risk populations 4

Risk Factors for TACO

Some risk factors for TACO include:

• Cardiovascular comorbidities 3
• Acute kidney injury 3
• Emergency surgery 3
• Pretransfusion diuretic use 3
• Plasma transfusion, especially in females 3

Comparison with Other Complications

Compared to other complications, TACO is:

• The leading cause of transfusion-related morbidity and mortality worldwide 4
• The most common cause of mortality associated with blood products 5