Transfusion-Associated Circulatory Overload (TACO)

What is transfusion-associated circulatory overload?

Transfusion-associated circulatory overload (TACO) is a condition that causes fluid to build up in your lungs and other parts of your body after a blood transfusion. It happens when your body can’t manage the amount of extra fluid added by the transfusion. It can make it hard to breathe, cause severe swelling and increase your blood pressure.

TACO happens during or within 12 hours of a transfusion and can be fatal. Call 911, go to the ER or alert your medical team at the hospital if you’re experiencing symptoms of transfusion-associated circulatory overload.

What are the symptoms of transfusion-associated circulatory overload?

Symptoms of transfusion-associated circulatory overload include:

• Shortness of breath (dyspnea). This might be constant or only when lying down.
• Cough.
• Chest pain.
• Blue skin, lips or nails (cyanosis).
• Swelling in your legs, ankles or neck.
• Racing heart (tachycardia).
• Dizziness or fainting.
• Severe headache.

Symptoms of TACO can start during the transfusion or up to 12 hours after the transfusion.

What causes transfusion-associated circulatory overload?

Transfusion-associated circulatory overload happens when too much fluid enters your circulatory system at one time. Too much pressure in your blood vessels can cause them to leak fluid into your lungs (pulmonary edema).

What are the risk factors for transfusion-associated circulatory overload?

You’re at higher risk for TACO if you:

• Are 60 years old or older.
• Have a history of cardiovascular disease, like heart failure or a heart attack (myocardial infarction).
• Have a history of kidney disease.
• Have COPD (chronic obstructive pulmonary disease).
• Have recently been on vasopressors (medications that increase your blood pressure) or loop diuretics (medications that help you get rid of excess fluid).
• Get a transfusion of red blood cells (though it can happen with any blood product).
• Have received multiple blood transfusions.

How is transfusion-associated circulatory overload diagnosed?

To diagnose TACO, your healthcare provider will examine you, take your blood pressure and ask you about your symptoms. They might perform an echocardiogram or take blood or imaging tests (like a chest X-ray or CT scan).

How do healthcare providers treat transfusion-associated circulatory overload?

Healthcare providers treat transfusion-associated circulatory overload with diuretics. You may also need oxygen therapy (or, in severe cases, mechanical ventilation) to help you breathe. If you experience TACO during a transfusion, your provider will stop the procedure and have you sit up at an angle to help your breathing.

Can transfusion-associated circulatory overload be prevented?

If you’re at a higher risk for circulatory overload, your provider might give the transfusion at a slower rate or give you diuretics as a preventive measure. Let your provider know if you’ve ever had circulatory overload with a transfusion in the past and ask if there are ways to reduce your risk.

What can I expect if I have transfusion-associated circulatory overload?

TACO can be mild to life-threatening. In some cases, it’s caught early and your provider stops the transfusion until they can restart it again safely. In other cases, it may not develop until hours after you complete the transfusion. If it’s severe, you may need to stay in the hospital (or stay longer than you already needed to).

What’s the mortality rate for transfusion-associated circulatory overload?

Studies report mortality (death) rates for TACO as high as 21%. While it only happens in about 1% of blood transfusions, it’s the leading cause of transfusion-related deaths.

When should I go to the ER?

Call 911 or go to the emergency room if you have symptoms of TACO after a blood transfusion. If you’re staying in the hospital, don’t hesitate to mention any symptoms to your care team as soon as possible.

A note from Cleveland Clinic

Blood transfusions are safe and often life-saving. But it’s also important to keep an eye out for side effects like circulatory overload, especially if you’re at a higher risk. Talk to your provider if you have concerns about your risk for blood transfusion reactions. If you experience any unusual symptoms after a blood transfusion, don’t hesitate to go to the ER or tell your medical team at the hospital.