What is transfusion-associated circulatory overload (TACO)?

By William Aird

Acute pulmonary edema due to volume overload from transfusion. Usual onset within 1-2 hours of transfusion. Risk factors include transfusion of large volumes of components or high flow rates. Treatment is supportive and may include lasix, and rarely therapeutic phlebotomy.

According to Nareg Roubinian, TACO is pulmonary edema primarily related to circulatory overload with criteria developed by the National Healthcare Safety Network including 3 or more of the following within 6 hours of transfusion:

  • Acute respiratory distress
  • Radiographic pulmonary edema
  • Elevated central venous pressure
  • Evidence of left heart failure
  • Elevated B-type natriuretic peptide (BNP)
  • Positive fluid balance

According to the AABB, TACO is defined as new onset or exacerbation of 3 or more of the following within 12 hours of cessation of transfusion:

  • Elevated brain natriuretic peptide (BNP) or NT-pro BNP relevant biomarker.
  • Evidence of cardiovascular system changes not explained by underlying medical condition (Elevated central venous pressure, evidence of left heart failure including development of tachycardia, hypertension, widened pulse pressure, jugular venous distension, enlarged cardiac silhouette and/or peripheral edema).
  • Evidence of fluid overload.
  • At least 1 of the following:
    • Evidence of acute or worsening respiratory distress (dyspnea, tachypnoea, cyanosis and decreased oxygen saturation values in the absence of other specific causes) and/or,
    • Radiographic or clinical evidence of acute or worsening pulmonary edema (crackles on lung auscultation, orthopnea, cough, a third heart sound and pinkish frothy sputum in severe cases).
From Hematology Am Soc Hematol Educ Program. 2018;2018:585-594.