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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.
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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.
Table 1.
Intake and output after the onset of transfusion-associated adverse reactions
| Intake and output | Before diuretics injection∗ | After diuretics injection† |
|---|---|---|
| Total intake (mL) | 1,742 | 795 |
| Oral (mL) | 20 | 0 |
| IVF (mL) | 430 | 270 |
| Blood (mL) | 1,292 | 525 |
| Total output (mL) | 225 | 590 |
| Urine (mL) | 225 | 590 |
| Feces (number) | 1 | 0 |
| Drainage (mL) | 0 | 0 |
Table 2.
Changes in laboratory findings
| Laboratory variables | Before transfusion | After transfusion | After 7 days |
|---|---|---|---|
| NT-proBNP∗ (pg/mL) | 20.03 | 971.70 | - |
| SO2 (%) | 98.5 | 92.6 | - |
| Intake/output (mL) | 720/125 | 1,742/225 | 1,200/1,430 |
| SBP/DBP (mmHg) | 105/72 | 165/97 | 130/81 |
| WBC (109/L) | 9.91 | 20.9 | 8.7 |
| Hb (g/dL) | 6.5 | 9.1 | 9.4 |
| Hct (%) | 20.3 | 27.7 | 30 |
| Platelet (109/L) | 56 | 28 | 39 |
| PT (sec) | 18.5 | 21.5 | 17.3 |
| PT (INR) | 1.65 | 1.93 | 1.54 |
| aPTT (sec) | 34.8 | 35.7 | 31.5 |
| BUN (mg/dL) | 8.6 | 12.6 | 21.8 |
| Creatinine (mg/dL) | 0.47 | 1.29 | 0.42 |
∗ NT-proBNP level measured 6 hours after the initiation of blood transfusion was higher than that measured 12 hours before the initiation of transfusion. Abbreviations: aPTT, activated partial thromboplastin time; BUN, blood urea nitrogen; SBP, systolic blood pressure; DBP, diastolic blood pressure; Hb, hemoglobin; Hct, hematocrit; NT-proBNP, N-terminal prohormone of brain natriuretic peptide; PT, prothrombin time; SO2, oxygen saturation; WBC, white blood cell.
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