Abdul Mannan: Preventing Transfusion Death Starts with Early Recognition of TACO
Abdul Mannan, Consultant Hematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:
“Every transfusion death we prevent starts with recognising TACO early.
Transfusion-Associated Circulatory Overload is the leading cause of transfusion-related mortality in the UK. And it’s largely preventable.
The concept is simple. Too much fluid, too fast, in someone whose heart can’t cope.
Here’s what every clinician giving blood needs to know:
- Elderly patients, those with cardiac or renal failure, and small-framed patients are at highest risk
- Watch for acute breathlessness, orthopnoea, tachycardia, hypertension, and bibasal crackles
- Once you suspect TACO, stop the transfusion immediately. Don’t slow it down. Stop it.
- Sit the patient upright, give oxygen, and start IV furosemide
- Monitor fluid balance closely and document everything
The single most useful clinical clue to differentiate TACO from TRALI?
Hypertension and a response to diuretics. TRALI won’t respond. TACO will.
SHOT (Serious Hazards of Transfusion) data consistently shows TACO is underreported and underrecognised, particularly in acute medical wards.
We can do better with a pre-transfusion checklist:
- Is this patient high risk?
- Can we slow the rate?
- Do we really need all four units today?
What’s your approach to preventing TACO in high-risk patients?”
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