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Transfusion-associated circulatory overload (TACO): prevention, management, and patient outcomes

Authors Roubinian N, Murphy E

Received 11 November 2014

Accepted for publication 7 February 2015

Published 24 April 2015 Volume 2015:3 Pages 17—28


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Cees Th. Smit Sibinga

Nareg H Roubinian,1,2 Edward L Murphy1–3

1Blood Systems Research Institute, 2Department of Laboratory Medicine, 3Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

Abstract: Transfusion-associated circulatory overload (TACO) is acute pulmonary edema associated with left atrial hypertension or volume overload occurring within 6 hours following a blood transfusion. Recognized by physicians as a common complication of blood transfusion, its incidence has been difficult to measure because active surveillance is required to counteract underreporting; active surveillance indicates overall incidence rates as high as 1% per transfused patient. Recent clinical and translational research has focused on the development of electronic alert systems to measure TACO incidence and provide alerts to physicians regarding patients at high risk. Translational research regarding the utility of biomarkers such as brain natriuretic protein (BNP) or N-terminal pro-BNP (NT-proBNP) as diagnostic tools for TACO has been only moderately successful, but the search for other biomarkers continues. Prevention strategies can be developed based upon evidence derived from both observational studies and might include: using documented risk factors to highlight patients at risk, preferably using real-time analysis of electronic medical records; implementation of modified transfusion strategies to minimize the volume and infusion rate of blood products; consideration of prophylactic diuretic therapy; and heightened diagnostic awareness combined with rapid implementation of treatment. Randomized clinical trials will be required to test such strategies before they are widely implemented. Finally, the occurrence of TACO ought to be considered as a potentially avoidable medical complication that could be used to benchmark transfusion and critical care practice across hospitals.

Keywords: blood transfusion, pulmonary edema, risk factors, prevention and control, therapeutics

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