Vox Sang. 2026 Mar 17. doi: 10.1111/vox.70237. Online ahead of print.
ABSTRACT
BACKGROUND AND OBJECTIVES: Transfusion-associated circulatory overload (TACO) is the leading cause of transfusion-related morbidity and mortality. We evaluated the incidence of TACO and its association with new fever (HOT-TACO) at a comprehensive cancer centre.
MATERIALS AND METHODS: Retrospective review of haemovigilance data (July 2019-October 2020) identified 100 possible to definite TACO cases. TACO cases were classified as HOT-TACO or regular TACO, differentiated by an association with new-onset fever. Both groups were assessed by type, age of blood products involved, reaction severity, cancer diagnosis and white blood cells (WBC) counts.
RESULTS: Among 1382 transfusion reactions in a 15-month period, 111 cases of TACO (8%) were diagnosed. A total of 100 adult TACO cases were included in this study; 16% of them were HOT-TACO cases. The median WBC counts pre- and post-transfusion in the HOT-TACO versus regular-TACO group were not statistically different (pre- 5.400 vs. 2.050, p = 0.19; post 4.100 vs. 1.900, p = 0.45). However, the HOT-TACO group had a 2.7-fold higher pre-WBC and a 2.2-fold higher post-WBC when compared with the regular TACO group. There were no significant differences in age of the blood products involved, red blood cell (RBC) age (median 12 days, p = 0.34), platelet age (single donor platelet [SDP]/random donor platelet [RDP] unit) (median 5/5 days, p = 0.32/p = 0.72) or reaction severity between groups.
CONCLUSION: We found an association of TACO and new fever in 16% of cases compared with 32% reported in a non-exclusive oncological setting. Findings are likely related to impaired immune response present in cancer patients associated with immunosuppression. Our findings support that fever should not be used to distinguish transfusion-related acute lung injury (TRALI) from TACO.
PMID:41844335 | DOI:10.1111/vox.70237
