What is the most common complication of blood transfusion?

The Most Common Complication of Blood Transfusion

The most common complication of blood transfusion is transfusion-associated circulatory overload (TACO). 1

Understanding TACO

Transfusion-associated circulatory overload (TACO) is now recognized as the most common cause of transfusion-related mortality and major morbidity. It is characterized by:

• Acute or worsening respiratory compromise and/or pulmonary edema during or up to 12 hours after transfusion 1
• Cardiovascular changes including tachycardia and hypertension not explained by the patient's underlying condition 1
• Evidence of fluid overload 1
• Supportive biomarker results such as elevated brain natriuretic peptide 1

Risk Factors for TACO

Several patient characteristics increase the risk of developing TACO:

• Older, non-bleeding patients (age >70 years) 1
• Pre-existing comorbidities:
  • Heart failure 1
  • Renal failure 1
  • Hypoalbuminemia 1
• Low body weight 1
• Rapid transfusion rate 1

Other Common Transfusion Reactions

While TACO is the most common serious complication, other reactions include:

Febrile Non-Hemolytic Transfusion Reactions

• More commonly associated with red blood cell units 1
• Presents with fever and chills 1
• Management typically involves intravenous paracetamol 1

Allergic Reactions

• More commonly associated with plasma and platelets 1
• Presents with urticaria and pruritus 1
• Management typically involves antihistamines 1

Bacterial Contamination

• Most frequently affects platelets due to room temperature storage 1
• Represents the most frequent infectious complication from blood products 1
• Limited shelf life of platelet units to 5 days due to risk of bacterial growth 1

Hemolytic Reactions

• Signs include hypotension, tachycardia, hemoglobinuria, and microvascular bleeding 1
• May be masked during general anesthesia 1

Prevention and Management of TACO

To reduce the risk of TACO, consider these preventive measures:

• Carefully assess the need for transfusion in high-risk patients 1
• Use body weight dosing of red blood cells 1
• Implement slow transfusion rates 1
• Monitor vital signs and fluid balance closely 1
• Consider prophylactic diuretic administration in high-risk patients 1

Monitoring for Transfusion Reactions

Proper monitoring is essential to identify reactions early:

• Monitor respiratory rate throughout transfusion (dyspnea and tachypnea are typical early symptoms of serious reactions) 1
• Record observations including pulse, blood pressure, and temperature before, during (15 minutes after start), and after each unit transfused 1
• Check for signs of bacterial contamination, TRALI, and hemolytic reactions 1
• Assess urine output and color 1
• Monitor peak airway pressure in ventilated patients 1

Clinical Implications

When administering blood products:

• Ensure proper patient identification to prevent ABO incompatibility 1
• Maintain appropriate storage conditions for blood products 1
• Have protocols in place for managing transfusion reactions 1
• Report adverse reactions to hemovigilance systems 1

Understanding that TACO is the most common serious complication of blood transfusion should guide clinicians to implement preventive strategies, particularly in high-risk patients.