PREVENTION OF TRANSFUSION-ASSOCIATED CIRCULATORY OVERLOAD (TACO): SPECIAL FOCUS ON "WEEKEND TACO" AND "ISOVOLEMIC TRANSFUSION"

Abstract

In 1985, Popovsky reported that Transfusion-Associated Circulatory Overload (TACO) occurred more frequently than expected in red blood cell (RBC) transfusions. From 2012, the Japanese Red Cross (JRC) started analyzing data on TACO cases. Here, we highlight a newly identified risk. The JRC diagnosed and classified 162 cases of TACO according to the day of the week of onset. The number of cases with TACO onset from Monday to Sunday was 17, 26, 28, 27, 32, 22, and 10, respectively. Because the supply of RBC units decreases towards the weekend, the TACO/RBC ratio was 3.5 times higher on Saturdays than on Mondays (p<0.01). In this report, we first focused on this apparent trend of "weekend TACO". Second, during transfusions, clinicians generally focus on incremental changes in patients' hemoglobin levels, while the increase in fluid infused with the blood components rarely receives as much attention. Because transfusion is a fluid infusion, it is directly correlated with the intravenous fluid load. We therefore recommend the proactive use of diuretics to maintain fluid balance before and after transfusion and emphasize the concept of "isovolemic transfusion".