Canterbury DHB


Transfusion-associated Circulatory Overload

In This Section


Clinical Features




This is probably the commonest non-immmunologic complication of blood transfusion. It occurs in 0.1 to 1% of transfusions, usually within 6 hours of transfusion. Risk factors include extremes of age, history of cardiovascular disease, renal dysfunction, large volume transfusions, and rapid transfusion rates. The pathophysiology is that of an acute rise in central venous pressure in the setting of reduced ventricular compliance, leading to pulmonary oedema.

The main differential diagnosis is TRALI (transfusion-related acute lung injury).

Clinical Features

Symptoms: Acute shortness of breath/respiratory distress

Signs: tachycardia, hypertension raised JVP, bibasal crepitations. Positive fluid balance is common. A fever is rare.


Serologic investigations are usually negative. BNP is usually elevated. Chest radiograph shows pulmonary congestion.


  1. Stop transfusion.
  2. Sit up the patient.
  3. Duiretics.
  4. Oxygen.
  5. Notify Blood Bank.

Note: Report TACO to NZBS.

About this Canterbury DHB document (644942):

Document Owner:

Not assigned (see Who's Who)

Last Reviewed:

June 2019

Next Review:

June 2022


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Topic Code: 644942