Raval J S, Mazepa M A, Russell S L, Immel C C, Whinna H C, Park Y A
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
Vox Sang. 2015 May;108(4):387-92. doi: 10.1111/vox.12234. Epub 2015 Mar 6.
Transfusion-associated circulatory overload (TACO) is the second leading cause of reported transfusion-related fatalities in the United States. While its occurrence has been previously investigated after red cell and plasma transfusion, no data are available regarding its association with platelet transfusion. Our goal was to determine the rate of platelet-associated TACO at our university medical centre.
This study had retrospective and prospective analyses. The 13-year retrospective analysis served to determine the historical rate of platelet-associated TACO by passive reporting. The 30-day prospective analysis included active surveillance of all non-emergently issued and non-operative platelet recipients ≥16 years old with no transfusions in the previous 6 h determined by analysis of blood bank product issue records. Data collected included demographics, vital signs pre- and posttransfusion, fluid balances, supplemental oxygen use, reports of dyspnoea, and infusion rates. For the prospective analysis, all variables were collected within 24 h of transfusion from the medical record and, when necessary, interviews with care providers and/or patients.
In the retrospective analysis, 366 reactions were reported, of which 6 (1·6%) were TACO. The historical rate of TACO was 1:5997 transfused platelet units. During the prospective analysis, 225 eligible patients received a total of 334 units of platelets. The average platelet transfusion volume was 261 ± 26 ml, and the average infusion rate was 391 ± 198 ml/h. Two unreported TACO reactions were discovered and characterized by new-onset hypertension, crackles on lung auscultation, dyspnoea, hypoxia and supplemental oxygen requirements which resolved completely with diuresis. The rate of TACO during this prospective analysis was 1:167 transfused platelet units.
Platelet-associated TACO is greatly underestimated by passive reporting in the adult patient population.
输血相关循环超负荷（TACO）是美国报告的输血相关死亡的第二大原因。虽然此前已对红细胞和血浆输血后的TACO发生情况进行过调查，但尚无关于其与血小板输血关联的数据。我们的目标是确定我校医学中心血小板相关TACO的发生率。
本研究采用回顾性和前瞻性分析。13年的回顾性分析旨在通过被动报告确定血小板相关TACO的历史发生率。30天的前瞻性分析包括对所有年龄≥16岁、非急诊且非手术的血小板受血者进行主动监测，这些受血者在过去6小时内未输血，通过分析血库产品发放记录确定。收集的数据包括人口统计学信息、输血前后的生命体征、液体平衡、补充氧气的使用情况、呼吸困难报告以及输注速率。对于前瞻性分析，所有变量均在输血后24小时内从病历中收集，必要时还会与医护人员和/或患者进行访谈。
在回顾性分析中，共报告了366例反应，其中6例（1.6%）为TACO。TACO的历史发生率为每输注5997个血小板单位中有1例。在前瞻性分析期间，225例符合条件的患者共接受了334个单位的血小板。平均血小板输注量为261±26毫升，平均输注速率为391±198毫升/小时。发现了2例未报告的TACO反应，其特征为新发高血压、肺部听诊有啰音、呼吸困难、缺氧以及需要补充氧气，经利尿后完全缓解。在此次前瞻性分析中，TACO的发生率为每输注血小板单位167例中有1例。
在成年患者群体中，被动报告极大地低估了血小板相关TACO的发生率。
