Premium
The practice of diagnosing and reporting transfusion‐associated circulatory overload: a national survey among physicians and haemovigilance officers
Author(s) -
Bosboom J. J.,
Klanderman R. B.,
Peters A. L.,
van de Weerdt E. K.,
Goudswaard E. J.,
Binnekade J. M.,
Zwaginga J. J.,
Beckers E. A. M.,
Geerts B. F.,
Hollmann M. W.,
Zeerleder S. S.,
van Kraaij M.,
Vlaar A. P.
Publication year - 2018
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/tme.12480
Subject(s) - medicine , preference , intensive care unit , emergency medicine , blood transfusion , transfusion medicine , family medicine , intensive care medicine , economics , microeconomics
SUMMARY Objectives This study aims at identifying factors that disciplines consider when diagnosing and reporting transfusion‐associated circulatory overload (‘TACO’). Background TACO is a clinical diagnosis based mainly on subjective factors. Therefore, TACO could be an underreported complication of blood transfusion. Methods A survey was conducted among critical care physicians, anaesthesiologists, haematologists, transfusion medicine physicians and haemovigilance officers using case vignettes and a questionnaire. Factors that may affect diagnosing TACO were investigated using conjoint analysis. A positive B‐coefficient indicates a positive preference for diagnosing TACO. Participants rated factors influencing reporting TACO on a 0‐ to 100‐point scale. Results One hundred and seven surveys were returned (62%). Vignettes showed preferences in favour of diagnosing TACO with the onset of symptoms within 2 h [β 0·4(−0·1–1·0)], positive fluid balance [β 0·9(0·4–1·5)] and history of renal failure [β 0·6(0·1–1·2)]. Compared with transfusion of a single unit of red blood cells (RBC), respondents showed a preference for diagnosing TACO following a single unit of solvent/detergent (S/D) plasma or pooled platelet concentrate (PPC) [β 0·3(−0·2–0·7) resp. 0·5(−0·1–1·2)]. Multiple transfusion (6 RBC + 4 S/D plasma) was a strong preference for diagnosing TACO compared to 1 RBC and 1 S/D plasma [β 0·3(−0·8–1·3)]. Respondents did not fully take into account new hypertension and tachycardia when reporting TACO [median 70 (IQR 50–80) resp. 60 (IQR 50–80)]. No differences were observed between disciplines involved. Conclusion When diagnosing and reporting TACO, physicians and haemovigilance officers do consider known risk factors for TACO. Reporting could be improved by increasing the awareness of haemodynamic variables in future education programmes.