What is the most frequent major complication of blood transfusion?

From the Guidelines

Transfusion-associated circulatory overload (TACO) is the most frequent major complication of blood transfusion. This condition is characterized by acute or worsening respiratory compromise and/or acute or worsening pulmonary oedema during or up to 12 h after transfusion, cardiovascular changes (tachycardia, hypertension) not explained by the patient’s underlying condition, evidence of fluid overload and supportive result of a relevant biomarker (e.g. brain natriuretic peptide) 1. The risk factors for developing TACO include older, non-bleeding patients (age >70 years), comorbidities (heart failure, renal failure and hypoalbuminaemia), low body weight and rapid transfusion 1.

Some key points to consider in the management and prevention of TACO include:

• Patient monitoring is essential to identify and manage adverse reactions, with particular attention to respiratory rate, pulse, blood pressure, and temperature 1
• Dyspnoea and tachypnoea are typical early symptoms of serious transfusion reactions, and the respiratory rate should be monitored throughout transfusion 1
• Observations should be completed and recorded before the start of the transfusion, 15 min after the start of each unit, and within 60 min of the end of transfusion 1

It is crucial to recognize TACO promptly and manage it appropriately to minimize morbidity and mortality associated with blood transfusions. The identification of TACO as the most common cause of transfusion-related mortality and major morbidity highlights the need for vigilant monitoring and careful patient selection for blood transfusion 1.

From the Research

Major Complications of Blood Transfusion

The most frequent major complication of blood transfusion is:

• Transfusion-associated circulatory overload (TACO) 2, 3, 4, 5

Characteristics of TACO

TACO is characterized by:

• Hydrostatic pulmonary edema following blood transfusion 3
• Occurrence within 6 to 12 hours of transfusion 5
• Association with advanced age, increased health care costs, and modest transfusion volumes 4

Risk Factors for TACO

Risk factors for TACO include:

• Being at an extreme of age 2
• Preexisting cardiac and/or renal dysfunction 2, 3
• Acute kidney injury 3
• Emergency surgery 3
• Pretransfusion diuretic use 3
• Plasma transfusion, especially in females 3

Incidence of TACO

The incidence of TACO is:

• 1% to 12% of at-risk populations 5
• 1 case per 100 transfused patients 3
• 1.05% in orthopedic surgery patients 4