S transfuzijo povezana volumska preobremenitev
Transfusion-associated circulatory overload (TACO)

slovenian

2024

volume 93, issue 11/12

Slovensko zdravniško društvo
(Obvezni izvod spletne publikacije)

Transfusion-associated circulatory overload (TACO) is the most common respiratory adverse transfusion reaction (ATR). TACO is defined as acute or worsening respiratory compromise and/or acute or worsening pulmonary oedema during or up to 12 hours of transfusion, with additional features including cardiovascular system changes not explained by the patient’s underlying medical condition, evidence of fluid overload, and a relevant biomarker. TACO is caused by a volume overload in predisposed individuals, such as patients with heart failure, the elderly, infants, patients with severe anaemia, and patients with positive fluid balance. On the other hand, suboptimal fluid management (e.g., a rapid transfusion of a large volume of blood product) or other components in the transfused product may enable the second hit in the two-hit TACO pathophysiology model. TACO treatment should include immediate cessation of the transfusion, placing the patient in an upright position, administering oxygen, diuretics, and other pulmonary oedema therapy. Mechanical ventilation and treatment in the intensive care unit may be required. Although TACO is the foremost cause of transfusion-related morbidity and mortality in countries with well-developed transfusion services in recent years, it has been historically both underrecognized and underreported. It remains very challenging to distinguish it from underlying causes of lung injury and/or fluid overload as well as from the other two respiratory ATRs: transfusion-related acute lung injury (TRALI), and transfusion-associated dyspnoea (TAD). This review article describes TACO, its 2018 ISBT/IHN/AABB definition, pathophysiology, clinical presentation, prevention, and treatment strategies, including a comparison table of all three primary respiratory ATR characteristics. TACO is a potentially fatal adverse complication of blood transfusion, and developing a thorough clinical understanding can improve haemovigilance reporting and can contribute to risk factor identification and preventative measures.

21.04.2025