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Haematological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Transfusing too much blood, or too fast, leads to acute cardiac decompensation and acute pulmonary oedema. Transfusion-associated circulatory overload (TACO) is now one of the commonest serious adverse transfusion events reported in the UK's annual SHOT (Serious Hazards of Transfusion) report. Particular care should be taken in adults with a low body mass index or history of congestive cardiac failure. All patients requiring transfusion should be assessed for their risk of developing TACO and, if necessary, measures should be taken to reduce the risk (e.g. using diuretics with transfusion and only transfusing one unit). Symptoms: breathlessness; coughSigns: basal crepitations; jugular venous pressure (JVP) ↑; tachycardiaManagement: oxygen, diuretic therapy
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Transfusion of blood can be a life-saving procedure; however, everyone’s blood is different, and transfusing blood that is incompatible with the recipient’s blood produces an acute haemolytic transfusion reaction that can be fatal. The hazards of transfusion do not only relate to incompatibility; blood is a complex liquid tissue and transfusion also carries the risk of: Febrile non-haemolytic transfusion reactions, which are usually mild.Reactions to bacterially contaminated blood, which can range from a mild pyrexia to potentially lethal septic shock.Transfusion-related acute lung injury (TRALI).Transfusion associated circulatory overload (TACO).Acute allergic reaction, ranging from mild urticaria to life threatening angio-oedema anaphylaxis.
Blood Transfusion
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Transfusion-associated circulatory overload (TACO) is increasingly a cause of morbidity associated with transfusion especially with the administration of fresh frozen plasma (FFP). It is simply a volume overload state in excess of what the patient's cardiac status can handle. The incidence of TACO is 1%–8%. It is characterised by acute dyspnoea associated with tachypnoea, hypertension and tachycardia. It can be be difficult clinically to differentiate TACO from TRALI.
Challenges to improving patient outcome following massive transfusion in severe trauma
Published in Expert Review of Hematology, 2020
Massive transfusion may also put patients at risk for both viral and bacterial infections. In the United States, the estimated risk for HIV is 1 in 2.135,000 while the greatest risk is for hepatitis B at 1 in 277,000 [34]. Platelet transfusions carry greater risks of infection, sepsis, and death than any other blood product, owing primarily to bacterial contamination [35]. Between 1:1000 and 1:2500 platelet units are bacterially contaminated. The skin bacterial microflora is a primary source of contamination, and enteric contaminants are rare but may be clinically devastating, while platelet storage conditions can support bacterial growth [35]. Transfusion-associated circulatory overload (TACO) which is the second leading cause of reported transfusion-related fatalities in the United States may be greatly underestimated by passive reporting [36]. The two most common types of electrolyte abnormalities to occur with massive transfusion are ionized hypocalcemia, caused by the preservative citrate and hyperkalemia.
Risk factors, management and prevention of transfusion-related acute lung injury: a comprehensive update
Published in Expert Review of Hematology, 2019
Susan A. Kuldanek, Marguerite Kelher, Christopher C. Silliman
Patients should not have evidence of fluid overload, including: cardiac failure, hypertension, positive fluid balance (liters) and/or elevated BNPs (brain natriuretic peptide: BNP <300 pg/mL or NT-proBNP <2000 pg/mL), distinguishing TRALI from TACO, the main differential diagnosis for TRALI; however, such BNP measurements are not reliable in the intensive care unit population in which TACO is not uncommon [22–24]. TACO is the most frequently transfusion-related respiratory complication and is most common in the intensive care unit patient population. TACO is usually the result of increased hydrostatic pressure leading to cardiogenic pulmonary edema, and fluid balance is an important distinguishing characteristic as TACO patients generally show evidence of fluid overload with elevated pre-transfusion fluid balances, which often results in hypertension [25]. Imaging will likely reveal fluffy infiltrates consistent with pulmonary edema, which may or may not be bilateral [25]. There is an immunologic component to TACO because, surprisingly, the degree of positive fluid balance demonstrates less of an association with the development of TACO than the development of circulatory overload in patients without TACO [24,26,27]. At a single institution the introduction of universal leukoreduction decreased the incidence of TACO [28]. Increased levels of circulating IL-10 also correlate with patients who develop TACO, though the pathophysiology of TACO is still under investigation [29].
A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia
Published in Hematology, 2019
Adrian Newland, Roy Bentley, Anna Jakubowska, Howard Liebman, Joanna Lorens, Markus Peck-Radosavljevic, Vanessa Taieb, Akiyoshi Takami, Ryosuke Tateishi, Zobair M. Younossi
PT has been used for over 50 years for active bleeding and prophylaxis in high-risk populations (eg, cancer patients or TCP patients undergoing invasive procedures) [9–12]. Most guidelines recommend a PC threshold of 50 × 109/L to prevent hemorrhage prior to invasive procedures but vary depending on the type of procedure [10,11,13,14]. Although widely used, PTs are associated with a variety of risks including infection (that may result in sepsis) [15–17], transfusion reactions and alloimmunization (up to 40%) [18–20]. PTs are associated with higher odds ratios of arterial thrombosis and mortality among TTP and HIT patients [21], and with higher rates of transfusion-associated circulatory overload (TACO) [22] and transfusion-related acute lung injury [23]. Any transfusion-related intervention can increase the risk of TACO which has been shown to be under-reported [24]. Thrombocytopenic patients who receive PTs also have a variety of underlying conditions and diseases, making the decision to transfuse difficult in light of potential risks [11,12,25–27].