TACO

Transfusion-Associated Circulatory Overload (TACO) is a potentially serious complication of blood transfusion caused by excessive or rapid administration of blood components, resulting in circulatory volume overload. It commonly occurs in patients with underlying heart or kidney disease, severe anaemia, extremes of age, or limited ability to tolerate increased fluid volume.

Symptoms usually develop during or within 12 hours after transfusion. Common clinical features include breathlessness, rapid breathing, low oxygen saturation, hypertension, tachycardia, cough, and signs of pulmonary oedema. Patients may also develop raised jugular venous pressure and peripheral swelling. Chest imaging can demonstrate pulmonary congestion or oedema, while laboratory findings may show an elevated natriuretic peptide level.

Management involves stopping or slowing the transfusion, providing oxygen, and treating fluid overload, usually with appropriate diuretic therapy. Severe cases may require non-invasive or invasive ventilatory support. Early recognition is essential to prevent respiratory failure and other complications.

Prevention focuses on identifying patients at increased risk before transfusion. Blood products should be administered at the minimum appropriate volume and infusion rate, with careful monitoring of vital signs and fluid balance. Diuretics may be considered for selected high-risk patients. TACO prevention is particularly important in elderly patients and those with cardiac or renal impairment.