From the Research
Lasix (furosemide) should generally not be held during blood transfusions unless there are specific concerns about volume overload. In fact, furosemide is sometimes deliberately administered during or after blood transfusions, typically at doses of 20-40 mg IV, to prevent or treat transfusion-associated circulatory overload (TACO) 1. This practice is particularly common in patients with heart failure, renal dysfunction, or other conditions predisposing them to fluid overload. The diuretic effect of furosemide helps manage the additional volume introduced by the transfusion by promoting urination and reducing intravascular volume. However, clinical judgment is essential, as some patients may require careful fluid balance monitoring during transfusions. If a patient is already volume depleted or hypotensive, furosemide administration might need to be reconsidered or the timing adjusted. Additionally, it's important to monitor electrolytes, particularly potassium levels, when administering furosemide during transfusions, as both the medication and stored blood products can affect electrolyte balance.
Some key points to consider:
- The use of furosemide in preventing TACO is supported by recent studies, including a dose-finding study that suggests 10-40 mg of furosemide IV may be required to achieve a diuresis volume of 400 mL, sufficient to offset 1 red blood cell unit 1.
- Clinical trials, such as a pilot, double-blind, randomized controlled trial, have shown that furosemide can be safely administered during blood transfusions without significant adverse effects 2.
- Animal studies have also demonstrated the potential of furosemide in preventing TACO, with a randomized controlled study in rats showing that furosemide can rapidly and dose-dependently decrease the rise in hydrostatic pulmonary pressure following transfusion 3.
- Despite the potential benefits of furosemide, it is not routinely ordered for RBC transfusion, even in patients with risk factors for TACO, highlighting the need for further studies to assess the safety, efficacy, optimal dose, and timing of furosemide in preventing TACO 4.
Overall, the decision to hold or administer Lasix during a blood transfusion should be made on a case-by-case basis, taking into account the individual patient's risk factors, medical history, and current clinical status. The most recent and highest quality study suggests that furosemide can be a useful tool in preventing TACO, but its use should be guided by clinical judgment and careful monitoring of the patient's response 1.