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TACO — RACP Adult Medicine MCQ

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EasyHaematologyTACORACP Adult Medicine

A 80-year-old woman with heart failure receives a rapid transfusion of 2 units of packed red cells. She develops acute dyspnoea, raised JVP, bilateral crackles, and peripheral oedema. CXR shows pulmonary oedema with cardiomegaly. BNP is markedly elevated. What is the most likely transfusion reaction?

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Correct answer: A — Transfusion-associated circulatory overload (TACO)

Pulmonary oedema after rapid transfusion with raised JVP, elevated BNP, and cardiomegaly in a patient with pre-existing cardiac disease is TACO. Key differentiator from TRALI: TACO has elevated BNP, raised CVP, positive fluid balance, and responds to diuretics. Prevention is slow transfusion rate (2–4 hours per unit) with furosemide between units in at-risk patients.

Reference: Australian Red Cross Lifeblood – 2024 – TACO; ISBT 2024