Transfusion-associated circulatory overload (TACO)

Question 1

What does TACO stand for?

Answer 1

Transfusion-associated circulatory overload

Also known as transfusion-induced hypervolemia.

Question 2

How does TACO differ from TRALI?

Answer 2

TACO is a type of cardiogenic pulmonary edema

In TACO, the left heart cannot handle the hydrostatic pressure from volume, leading to transudation into the alveoli.

Question 3

What is the USMLE answer if a patient presents with ARDS-like symptoms more than 6 hours after a transfusion?

Answer 3

It is likely TACO.

This also applies if the patient has a history of cardiovascular disease regardless of time frame.

Question 4

What are the two presentations for TACO after a transfusion?

Answer 4

1) ARDS-like symptoms >6 hours after transfusion without cardiovascular history
2) Respiratory distress following transfusion regardless of time frame in patients with cardiovascular history

Question 5

What is the next best step in diagnosis for TACO if a patient develops bilateral crackles and low O2 saturation 12 hours after transfusion?

Answer 5

X-ray of the chest

Question 6

In which case would you suspect TACO regardless of the time frame after a transfusion?

Answer 6

If the patient has a history of heart failure or myocardial infarction (MI).

Question 7

If a patient develops ARDS-like symptoms after a transfusion and it occurs in less than 6 hours, what is the likely diagnosis?

Answer 7

TRALI.

Question 8

If a 72-year-old patient with a history of MI experiences shortness of breath and bilateral crackles 30 minutes after transfusion, what condition is suggested?

Answer 8

TACO.