TY - JOUR
T1 - The recipe for TACO
T2 - A narrative review on the pathophysiology and potential mitigation strategies of transfusion-associated circulatory overload
AU - Bulle, Esther B.
AU - Klanderman, Robert B.
AU - Pendergrast, Jacob
AU - Cserti-Gazdewich, Christine
AU - Callum, Jeannie
AU - Vlaar, Alexander P. J.
N1 - Funding Information: This research was supported by a Landsteiner Foundation for Blood Research (LSBR) fellowship grant to A.P.J. Vlaar, number 1931F . From the Landsteiner Foundation for Blood Transfusion Research, Haarlem – The Netherlands. The funding body were in no way involved in the study design, collection, analysis and the interpretation of data, nor in writing the manuscript. Funding Information: This research was supported by a Landsteiner Foundation for Blood Research (LSBR) fellowship grant to A.P.J. Vlaar, number 1931F. From the Landsteiner Foundation for Blood Transfusion Research, Haarlem ? The Netherlands. The funding body were in no way involved in the study design, collection, analysis and the interpretation of data, nor in writing the manuscript. Publisher Copyright: © 2021
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Cardiac overload
KW - Hydrostatic pulmonary edema
KW - Transfusion
KW - Volume overload
UR - http://www.scopus.com/inward/record.url?scp=85116827676&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.blre.2021.100891
DO - https://doi.org/10.1016/j.blre.2021.100891
M3 - Review article
C2 - 34627651
SN - 0268-960X
JO - Blood Reviews
JF - Blood Reviews
M1 - 100891
ER -