TACO

Transfusion associated circulatory overload (TACO)

Updated: 07/28/2025

© Jun Wang, MD, PhD

 

General features

• Pulmonary edema secondary to excessive circulating volume
• Definition: New onset or exacerbation of three or more of the following within 12 hours of transfusion completed, without other explanation

o   Respiratory distress

o   Pulmonary edema on PE or image studies

o   Elevated brain natriuretic protein (BNP) or N-terminal pro-hormone BNP

o   Elevated central venous pressure, etc

• May be associated with transfusion of any blood product
• Risk factors include pre-existing cardiac or kidney dysfunction, age (children or elderly), anemia, and chronic pulmonary diseases
• Associated with rapid transfusion of large quantities of fluid

Clinical presentations

• Acute onset
• Usually NO fever, urticaria or angioedema
• Presentation of congestive heart failure

o   Dyspnea, coughing, orthopnea, bilateral rales, hypoxia

o   Systolic hypertension, tachycardia

o   Jugular venous distension, pedal edema

o   Headache

Radiological findings

• Bilateral basilar infiltrate
• Widened cardiac silhouette

Key pathogenesis

• Excessive circulatory volume results in congestive heart failure

Laboratory findings

• Elevated BPN or NT-proBNP

Management

• Stop transfusion
• Supportive management: oxygen, intubation, etc
• Diuretics
• Prevention: Control infusion rate (1ml/kg/hour), split units

 

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