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Transfusion-Associated Circulatory Overload
Incidence
TACO is estimated to occur in up to 1% of transfusions, with higher rates reported in studies using active surveillance methodologies. For several reasons, TACO is likely one of the most underreported transfusion complications to hospital transfusion. A retrospective Medicare database review of over 2 million transfusions showed that patient characteristics such as age (greater than 85 years), history of heart failure, female sex, white race, and a history of chronic pulmonary disease inferred a greater risk of developing TACO. Epidemiologic data suggest that additional risk factors for TACO include being at the extremes of age, having a positive fluid balance, undergoing orthopedic surgery, having an acute myocardial infarction, and having renal failure. Higher rates of infusion, larger transfusion volumes, and transfusion of plasma are additional risk factors for the development of TACO.
Clinical Manifestations
Symptoms of TACO include dyspnea, orthopnea, cough, chest tightness, cyanosis, hypertension, and congestive heart failure. Tachycardia and a widened pulse pressure may also occur. TACO generally occurs toward the end of a transfusion but may occur up to 6 hours afterward.
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