hematology and oncology
Complications of Transfusion
Transfusion associated circulatory overload (TACO)
Although transfusion-associated circulatory overload is underrecognized and underreported, it has been recognized as the most common cause of transfusion-related deaths reported to the FDA ( General references ). The high osmotic load of blood products draws volume into the intravascular space over the course of hours, which can cause transfusion-associated circulatory overload in susceptible patients (eg, those with cardiac or renal insufficiency). RBCs should be infused slowly. The patient should be observed and, if signs of Typical treatment is with a diuretic such asfurosemide20 to 40 mg IV. Occasionally, patients requiring a higher volume of plasma infusion to reverse awarfarinoverdose may be given a low dose offurosemidesimultaneously; however,prothrombin complex concentrate(PCC) is the first choice for such patients. Patients at high risk of transfusion-associated circulatory overload (eg, those with heart failure or severe renal insufficiency) are treated prophylactically with a diuretic (eg,furosemide20 to 40 mg IV). 