Definition
Acute or worsening respiratory compromise and/or acute or worsening pulmonary oedema during or up to 12 hours after transfusion.
Can occur after transfusion of relatively small volumes if there are patient risk factors.
Frequency
Rare (≥1/10,000 to <1/1,000), however it is thought to be under-reported.
TACO is the leading cause of morbidity and mortality related to transfusion.
Reducing the risk
Perform a TACO pre-transfusion risk assessment - before transfusion. If risks are identified, consider whether the transfusion can be safely deferred until the issue is investigated, treated, and resolved..
TACO mitigations - if proceeding with transfusion:
• Calculate the volume to transfuse in mL for non-bleeding patients with a Hb target [this is essential in neonatal/paediatric patients]
• Minimal (usually single unit) unit transfusion for patients with symptomatic severe chronic anaemia, with *pharmacological* treatment as appropriate
• Measure the fluid balance
• Use of diuretics (where not contra-indicated)
• Close monitoring of the patient including oxygen saturation
• Clinical review of the patient after each unit transfused
Further information/ resources
SHOT Transfusion-Associated Circulatory Overload (TACO) Cumulative Data