The recipe for TACO: A narrative review on the pathophysiology and potential mitigation strategies of transfusion-associated circulatory overload

Esther B Bulle; Robert B Klanderman; Jacob Pendergrast; Christine Cserti-Gazdewich; Jeannie Callum; Alexander P J Vlaar

doi:10.1016/j.blre.2021.100891

The recipe for TACO: A narrative review on the pathophysiology and potential mitigation strategies of transfusion-associated circulatory overload

Blood Rev. 2022 Mar:52:100891. doi: 10.1016/j.blre.2021.100891. Epub 2021 Oct 2.

Authors

Esther B Bulle¹, Robert B Klanderman², Jacob Pendergrast³, Christine Cserti-Gazdewich⁴, Jeannie Callum⁵, Alexander P J Vlaar⁶

Affiliations

¹ Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), University of Amsterdam, Amsterdam UMC, the Netherlands. Electronic address: e.b.bulle@amsterdamumc.nl.
² Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), University of Amsterdam, Amsterdam UMC, the Netherlands. Electronic address: r.b.klanderman@amsterdamumc.nl.
³ Laboratory Medicine Program, University Health Network, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. Electronic address: Jacob.pendergrast@uhn.ca.
⁴ Laboratory Medicine Program, University Health Network, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. Electronic address: Christine.cserti@uhn.ca.
⁵ Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Canada. Electronic address: Jeannie.Callum@kingstonhsc.ca.
⁶ Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), University of Amsterdam, Amsterdam UMC, the Netherlands. Electronic address: a.p.vlaar@amsterdamumc.nl.

PMID: 34627651
DOI: 10.1016/j.blre.2021.100891

Abstract

Transfusion associated circulatory overload (TACO) is one of the leading causes of transfusion related morbidity and mortality. TACO is the result of hydrostatic pulmonary edema following transfusion. However, up to 50% of all TACO cases appear after transfusion of a single unit, suggesting other factors, aside from volume, play a role in its pathophysiology. TACO follows a two-hit model, in which the first hit is an existing disease or comorbidity that renders patients volume incompliant, and the second hit is the transfusion. First hit factors include, amongst others, cardiac and renal failure. Blood product factors, setting TACO apart from crystalloid overload, include colloid osmotic pressure effects, viscosity, pro-inflammatory mediators and storage lesion byproducts. Differing hemodynamic changes, glycocalyx injury, endothelial damage and inflammatory reactions can all contribute to developing TACO. This narrative review explores pathophysiological mechanisms for TACO, discusses related therapeutic and preventative measures, and identifies areas of interest for future research.

Keywords: Cardiac overload; Hydrostatic pulmonary edema; Transfusion; Volume overload.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Blood Transfusion
Comorbidity
Humans
Pulmonary Edema* / epidemiology
Pulmonary Edema* / etiology
Risk Factors
Transfusion Reaction* / etiology