Transfusion-associated circulatory overload (TACO) is currently one of the leading causes of transfusion-related deaths even though it is often underdiagnosed and underreported. Diagnosing TACO can be challenging, and two sets of criteria exist for adults—one from the US Centers for Disease Control and Prevention and the other from the International Society of Blood Transfusion (ISBT). Neither set of criteria, however, are specific for children. In order to gain a better understanding of TACO in children, a study evaluated 136 pediatric intensive care unit (PICU) patients (median age 12 months) who were transfused. The definitions were based on acute respiratory distress, tachycardia, increased blood pressure, edema on chest radiograph and positive fluid balance. One method used to diagnose TACO was textbook pediatric reference values, while the other method used a 10% or 20% difference compared to pre-transfusion values. The incidence of TACO varied widely between these methods from 1.5% to 76% in the same PICU patients, highlighting the need for better definitions to diagnose TACO in children.
