Transfusion-Associated Circulatory Overload (TACO)

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 in 10,000 to <1 in 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

TACO mitigations (if proceeding with transfusion):

• Calculate the volume to transfuse (in millilitres, mL) for non-bleeding patients with a haemoglobin (Hb) target. This is essential in neonatal/paediatric patients.
• Minimal (usually single) unit transfusion for patients with symptomatic severe chronic anaemia, with pharmacological treatment as appropriate
• Measure the fluid balance
• Use of diuretics (where not contraindicated)
• Close monitoring of the patient including oxygen saturation
• Clinical review of the patient after each unit transfused

Further information and resources

Serious Hazards of Transfusion (SHOT) resources:

• Transfusion-Associated Circulatory Overload (TACO) cumulative data