Transfusion-associated circulatory overload

Background

  • Often confused with TRALI
  • Frequently with rapid admin and large volume transfusions
  • Associated with a rapid rise in blood pressure, not hypotension
  • Essentially a CHF exacerbation 2/2 increased volume

TRALI vs TACO

TRALI TACO
Onset Acute, within 6hrs Often more gradual
BP Low High
Temp Febrile Normal
JVD/pedal edema Unlikely Likely
CVP/PAWP Normal Elevated
BNP Normal Elevated
Resp Dyspneic Dyspneic
CXR B/l infiltrates B/l infiltrates

Clinical Features

  • Dyspnea, orthopnea, peripheral edema, rapid rise in BP

Differential Diagnosis

Transfusion Reaction Types

Acute allergic reaction

Evaluation

  • BNP or NT-proBNP to differentiate from other lung injury

Management

  • Treat like normal CHF exacerbation
    • Supportive care
    • O2 and possibly BiPAP
    • Diuretics

Disposition

See Also

External Links

References