수혈관련 순환량과다 (TACO)

• 정의: 과도한 수혈에 의한 Circulatory overload로 인해 폐부종 및 급성 호흡 곤란이 발생하는 경우

• 임상 양상: 호흡곤란, 목정맥압 증가, 고혈압, 빈맥, 빈호흡, 폐 수포음, 이뇨제 투여시 호전, BNP상승,

• 진단기준

  • 수혈 중 또는 수혈 후 12시간 이내로 Required criteria 중 하나 이상을 만족하면서, 총 3가지 criteria를 만족하는 경우

    Required criteria

    A. Acute or worsening respiratory compromise

    B. Evidence of acute or worsening pulmonary edema based on

    → clinical physical examination and/or
    → radiographic chest imaging and/or non-invasive assessment of cardiac function (e.g. echocardiogram)

    Additional criteria

    C. evidence for cardiovascular system changes not explained by the patient’s underlying medical condition, including development of tachycardia, hypertension, widened pulse pressure, jugular venous distension, enlarged cardiac silhouette and/or peripheral oedema
    D. Evidence of fluid overload including any of the following: a positive fluid balance; response to diuretic therapy combined with clinical improvement; and change in the patient’s weight in the peri-transfusion period

    E. Supportive result of a relevant biomarker e.g. an increase of BNP or NT-pro BNP

• 치료: 수혈 중단, 산소, 이뇨제

[1] Transfusion-associated circulatory overload (TACO) Definition (2018), International Society of Blood Transfusion (ISBT)

[2] Harrison 21e, pg.895