The patient with acute cardiovascular problems
Peate Ian, Dutton Helen in 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.
Haematological Disease
John S. Axford, Chris A. O'Callaghan in 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
Blood Transfusion
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal in Principles of Physiology for the Anaesthetist, 2020
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.
The Limits of Individualism: Potential Societal Harms from the EAP for Convalescent Plasma
Published in The American Journal of Bioethics, 2020
But the collective consequences of individual decisions have serious repercussions. As in any problem of the commons, individuals acting in their own self-interest can result in everyone being worse off. Failure to acknowledge the communal good as an important part of the responsibility of physicians has resulted in a threat to the integrity of our research enterprise. Without rigorous clinical trials, we will be left not knowing if treatments work or outweigh the risks. Furthermore, even when considering only the benefit/harm ratio for an individual patient, it is important for the physician and patient to consider that CVP has potential risks. Known risks of plasma transfusion include TACO (transfusion associated circulatory overload) and TRALI (transfusion related acute lung injury); there may be additional, unexpected risks specific to CVP. While we await the results of randomized controlled trials, the vast majority of CVP recipients in the US are being transfused according to the EAP, potentially being subjected to harms of transfusion without receiving any benefit. If we find out that there is no benefit to CVP, then we will have subjected tens of thousands of patients to the risks of CVP without providing any benefit.
Platelet and red cell transfusions for neonates: lifesavers or Trojan horses?
Published in Expert Review of Hematology, 2019
Suzanne F. Fustolo-Gunnink, Charles C. Roehr, Lani Lieberman, Robert D. Christensen, Johanna G. Van Der Bom, Christof Dame, Antonio Del Vecchio, Amy K. Keir, Anna Curley, Simon J. Stanworth, Enrico Lopriore
(E) Several studies have suggested associations between RBC or platelet transfusions and other adverse outcomes. In general, transfusions are associated with a potential risk of infectious disease transmission (especially hepatitis), transfusion-related lung injury (TRALI) and transfusion-associated circulatory overload (TACO). In preterm neonates, RBC transfusions have been associated with increased rates of intraventricular hemorrhage (IVH), NEC, ROP and iron overload [7]. In addition, the PlaNeT-2 trial showed increased rates of BPD in the high threshold platelet transfusion arm. Though confirmation of these results in additional studies is needed, in the context of the recent trials these associations do warrant caution when transfusing preterm neonates.
Related Knowledge Centers
- Adverse Effect
- Blood Transfusion
- Hypervolemia
- Hypoxemia
- Peripheral Edema
- Shortness of Breath
- Tachycardia
- Hypertension
- Blood
- Transfusion Medicine
- Shortness of Breath