Transfusion-associated circulatory overload

Background

• Often confused with TRALI
• Frequently with rapid admin and large volume transfusions
• Associated with a rapid rise in blood pressure, not hypotension
• Essentially a CHF exacerbation 2/2 increased volume

TRALI vs TACO

	TRALI	TACO
Onset	Acute, within 6hrs	Often more gradual
BP	Low	High
Temp	Febrile	Normal
JVD/pedal edema	Unlikely	Likely
CVP/PAWP	Normal	Elevated
BNP	Normal	Elevated
Resp	Dyspneic	Dyspneic
CXR	B/l infiltrates	B/l infiltrates

Clinical Features

• Dyspnea, orthopnea, peripheral edema, rapid rise in BP

Differential Diagnosis

Transfusion Reaction Types

• Acute
  • Intravascular hemolytic tranfusion reaction
  • Febrile nonhemolytic tranfusion reaction
  • Allergic tranfusion reaction
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
  • Transfusion-associated graft-versus-host disease
  • Fluid overload
  • Sepsis
• Delayed
  • Extravascular hemolytic tranfusion reaction
  • Graft-vs-host disease
  • Tranfusion Infections

Acute allergic reaction

• Allergic reaction/urticaria
• Anaphylaxis
• Angioedema
• Asthma exacerbation
• Anxiety attack
• Scombroid
• Cold urticaria
• Contrast induced allergic reaction
• Shock
• Transfusion reaction
• Carcinoid syndrome

Evaluation

• BNP or NT-proBNP to differentiate from other lung injury

Management

• Treat like normal CHF exacerbation
  • Supportive care
  • O2 and possibly BiPAP
  • Diuretics

See Also

• Transfusion reaction

References

Authors

Ross Donaldson, Daniel Eggeman, Neil Young