The practice of diagnosing and reporting transfusion-associated circulatory overload: a national survey among physicians and haemovigilance officers

J J Bosboom; R B Klanderman; A L Peters; E K van de Weerdt; E J Goudswaard; J M Binnekade; J J Zwaginga; E A M Beckers; B F Geerts; M W Hollmann; S S Zeerleder; M van Kraaij; A P Vlaar

doi:10.1111/tme.12480

The practice of diagnosing and reporting transfusion-associated circulatory overload: a national survey among physicians and haemovigilance officers

Transfus Med. 2018 Oct;28(5):363-370. doi: 10.1111/tme.12480. Epub 2017 Oct 23.

Authors

J J Bosboom¹, R B Klanderman^{2

3}, A L Peters^{2

3}, E K van de Weerdt², E J Goudswaard², J M Binnekade², J J Zwaginga^{4

5}, E A M Beckers⁶, B F Geerts¹, M W Hollmann^{1

3}, S S Zeerleder⁷, M van Kraaij⁵, A P Vlaar^{2

3}

Affiliations

¹ Department of Anaesthesiology, Academic Medical Centre, Amsterdam, the Netherlands.
² Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
³ Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Amsterdam, the Netherlands.
⁴ Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands.
⁵ Centre for Clinical Transfusion Research, Sanquin Blood Supply, Sanquin Research, Leiden, the Netherlands.
⁶ Department of Internal Medicine - Haematology, Maastricht University Medical Centre, Maastricht, the Netherlands.
⁷ Department of Internal Medicine - Haematology, Academic Medical Centre, Amsterdam, the Netherlands.

PMID: 29058354
DOI: 10.1111/tme.12480

Abstract

Objectives: This study aims at identifying factors that disciplines consider when diagnosing and reporting transfusion-associated circulatory overload ('TACO').

Background: TACO is a clinical diagnosis based mainly on subjective factors. Therefore, TACO could be an underreported complication of blood transfusion.

Methods: A survey was conducted among critical care physicians, anaesthesiologists, haematologists, transfusion medicine physicians and haemovigilance officers using case vignettes and a questionnaire. Factors that may affect diagnosing TACO were investigated using conjoint analysis. A positive B-coefficient indicates a positive preference for diagnosing TACO. Participants rated factors influencing reporting TACO on a 0- to 100-point scale.

Results: One hundred and seven surveys were returned (62%). Vignettes showed preferences in favour of diagnosing TACO with the onset of symptoms within 2 h [β 0·4(-0·1-1·0)], positive fluid balance [β 0·9(0·4-1·5)] and history of renal failure [β 0·6(0·1-1·2)]. Compared with transfusion of a single unit of red blood cells (RBC), respondents showed a preference for diagnosing TACO following a single unit of solvent/detergent (S/D) plasma or pooled platelet concentrate (PPC) [β 0·3(-0·2-0·7) resp. 0·5(-0·1-1·2)]. Multiple transfusion (6 RBC + 4 S/D plasma) was a strong preference for diagnosing TACO compared to 1 RBC and 1 S/D plasma [β 0·3(-0·8-1·3)]. Respondents did not fully take into account new hypertension and tachycardia when reporting TACO [median 70 (IQR 50-80) resp. 60 (IQR 50-80)]. No differences were observed between disciplines involved.

Conclusion: When diagnosing and reporting TACO, physicians and haemovigilance officers do consider known risk factors for TACO. Reporting could be improved by increasing the awareness of haemodynamic variables in future education programmes.

Keywords: critical care; haematology; haemovigilance; transfusion; volume overload.

MeSH terms

Adult
Aged
Aged, 80 and over
Blood Safety*
Female
Humans
Male
Middle Aged
Physicians*
Practice Guidelines as Topic
Risk Factors
Surveys and Questionnaires*
Transfusion Reaction / diagnosis*
Transfusion Reaction / epidemiology