Farhana Islam1, Md. Mazharul Hoque2, Doulatun Nahar3, Md Badrul Islam4,Khairul Islam5, Sheikh Daud Adnan6, Barkatullah7, Md. Naimul Hoque8,Sufia Begum9, Jolly Biswash10, SM Mostofa Kamal11,Md. Shahedur Rahman Khan8, Abu Raihan8, Bashir Ahmed8

Abstract:
Transfusion-associated circulatory overload (TACO) is cardiogenic pulmonary
oedema due to infusion of rapid or large volume blood product. TACO is a frequent,
serious, but under-recognized complication of haemotherapy. Presenting
symptoms include dyspnoea, cyanosis, tachycardia and increased blood pressure.
Pedal oedema, headache, chest tightness and dry cough are additional
manifestations. Chest radiographs reveal pulmonary oedema and cardiomegaly.
Vulnerable patients are the very young and persons over 60 years. While rapid
infusion or massive transfusion are frequently the precipitating factors, relatively
small volumes (1–2 units) are sufficient to trigger the congestive heart failure.
Both haeme and non-haeme fluids account for the positive fluid balance. Freshfrozen
plasma (FFP) and autologous red blood cells have been implicated as well.
Consequences include longer length of intensive care unit and hospital stay. The
fatality rate has been reported to be 1–3%, but this may understate the true rate.
The incidence has been reported to be 1–8% in orthopaedic surgical populations.
In general hospital populations a range of 1 : 708–1 : 4075 red blood cell
transfusions is associated with TACO. In the intensive care setting, an incidence
of 1 : 356 components has been demonstrated. TACO is frequently confused with
transfusion-related acute lung injury (TRALI). In some cases, TRALI and TACO
may co-exist. A potentially important diagnostic tool is brain natriuretic peptide.
Brain natriuretic peptide is elevated in TACO and a post-transfusion-to-pretransfusion
ratio of 1·5 is indicative of the diagnosis. The test has a sensitivity of
81% and a specificity of 89%. Treatment includes supplementary oxygen, diuretics,
placing the patient in a sitting position and therapeutic phlebotomy in 250-ml
increments. While rapid infusion is believed to be a contributing factor, optimal

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