• Andrea Piccin, Gilbert Spizzo, Mark A Popovski, Francesco P Russo, Luca Armanaschi, Cinzia Vecchiato, Antonio Frena, and Andrea Mega.
• Department of Haematology and Oncology, Innsbruck Medical University, Innsbruck, Austria.
• Blood Transfus. 2021 May 1; 19 (3): 197-204.

BackgroundTransfusion-associated circulatory overload (TACO) is a rare life-threatening event associated with transfusion. This study aimed to identify any case of TACO in a large cohort of highly transfused patients with gastrointestinal tract (GI) bleeding.Materials And MethodsData from patients who underwent an oesophago-gastro-duodenoscopy (OGD) were collected over one year from the gastroenterology service of a regional hospital.ResultsA total of 278 patients were identified, of which 81 required transfusion. In total, 811 blood components were transfused (red cell concentrate, platelets, plasma), leading to a cumulative TACO incidence of 12.3%. The probability of developing TACO was greater for patients aged ≥80 years (OR=3.9%; p=0.0058), with renal disease (OR=1.9%, p=not significant) and with cardiac disease (OR 11.1%; p=0.003). Patients with TACO had a lower overall survival (52 vs 20% at 3 years, p=0.034, HR=2.19, 95% CI: 1.04-4.63) compared to patients with cirrhosis without TACO (57 vs 28% at 3 years, p=0.003, HR=2.20, 95% CI: 1.30-3.72). Patients with an advanced stage of liver cirrhosis (Child Pugh c10 or more) were most likely to develop TACO.DiscussionThis study shows that within the GI setting TACO may be markedly under-reported. Clinical awareness for potential TACO development in GI patients with cardiac or renal disease or age >80 years is now required.

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