(P-TS-84) Prevalence of Unreported Transfusion Associated Circulatory Overload Among High-Risk Veterans

Transfusion-associated circulatory overload (TACO) ranks high in hemovigilance reports for transfusion-related morbidity and mortality in the USA.  Risk factors for TACO include advanced age and comorbidities such as cardiac failure, chronic pulmonary disease, renal dysfunction, and severe anemia where the transfusion recipient cannot compensate for increased circulating blood volume. TACO has a poorly understood and complex pathophysiology and is under-reported as a complication of blood transfusion. This study sought to gain insight into unreported TACO among transfused veterans.

Study

Design/Methods: A retrospective cross-sectional study, using data from the EMR of transfused patients at a VA Medical Center between January 1, 2018 - December 31, 2022, assessed the relation between comorbidities, transfused products, and the development of TACO. Associated risk between the existence of one comorbidity or the combination of 2 or more comorbidities and the development of TACO was also evaluated. Patient outcomes were determined based on mortality or escalation of care (EOC) - respiratory support, diuretics, dialysis, and/or transfer to the intensive care unit within 24 hours post-transfusion. Pearson’s chi-square, with significance of p< 0.05, was used to assess the relation between each co-morbidity or a combination of co-morbidities, and the development of TACO, as well as the association between possible TACO and patient outcomes.

Results/Findings:

Table 1 summarizes gender, age, and occurrence of comorbidities in the study population, with a significant relation between both age range and gender with comorbidity (both p< .001). For the study, 232 patients were reviewed, with a mean age of  71.6 years (range 31-94 years). A total of 404 blood products were transfused to these patients, with a maximum of 7 RBC in one event. A combination of RBC, PLT and plasma was transfused to 194 patients. The remainder received only RBCs. Suspected TACO was not reported for any transfusion event.

Symptoms of TACO were seen in 63 patients [cardiovascular (CV): 33 (52.4%); respiratory distress (RD) and CV: 16 (25.4%); RD alone: 10 (15.9%); RD, CV, and fluid overload: 4 (6.3%)]. No pre- and post-transfusion BNP or NT-pro-BNP were obtained for any patient. Of these patients, 34 (54.0%) received EOC, including 5 patients who expired. The association between the symptoms of TACO and EOC was significant (p < .001).

Conclusions: The results of this study show unreported cases of suspected TACO among veterans. Failure to recognize the onset of TACO may lead ineffective clinical evaluation for at-risk patients. Further studies on the occurrence of suspected TACO would be valuable to improve transfusion practices, reduce the incidence of TACO, and subsequently improve patient outcomes.