Lab Med Online.  2019 Jan;9(1):30-34. 10.3343/lmo.2019.9.1.30.

A Case Report of Transfusion-associated Circulatory Overload

• Kim D
• Nah H
• Kim S
• Kim HO

• KMID: 2430208
• DOI: http://doi.org/10.3343/lmo.2019.9.1.30

Abstract

Transfusion-associated circulatory overload (TACO) is recently becoming more important than transfusion-related acute lung injury (TRALI) in terms of the number of patients with definite diagnosis as well as its prognosis. In order to diagnose TACO, it is helpful to recognize early the symptoms suspicious of transfusion reaction through electronic medical record system and computer network, and this will be of help for obtaining samples for brain natriuretic peptide (BNP) measurement before and after the onset of transfusion reaction. We report a case in which a transfusion reaction was diagnosed as TACO. A 62-year-old woman was admitted to the emergency room due to bleeding tendency. Two fresh frozen plasma units and one unit of leukocyte-reduced red blood cells were transfused. Blood pressure increased during transfusion, and the chest X-ray showed findings suggestive of newly developed pulmonary edema. N-terminal prohormone of BNP (NT-proBNP) test was carried out using the specimens in refrigerated storage. Compared with the NT-proBNP level measured 12 hours before the transfusion, that measured 6 hours after the transfusion was markedly increased (>48 fold of pre-transfusion level). As a result, this case was diagnosed with TACO.

Keyword

Transfusion reaction; Transfusion-associated circulatory overload; Brain natriuretic peptide (BNP); N-terminal prohormone of brain natriuretic peptide (NT-proBNP)

MeSH Terms

Acute Lung Injury
Blood Pressure
Diagnosis
Electronic Health Records
Emergency Service, Hospital
Erythrocytes
Female
Hemorrhage
Humans
Middle Aged
Natriuretic Peptide, Brain
Plasma
Prognosis
Pulmonary Edema
Thorax
Transfusion Reaction
Natriuretic Peptide, Brain

Figure

• 

  Fig. 1. Changes in chest X-ray before (A) and after (B) transfusion. Mild haziness in both lung fields was newly developed, suggesting pulmonary edema.

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