Can volume‐reduced plasma products prevent transfusion‐associated circulatory overload in a two‐hit animal model?

Abstract

Background and Objectives Transfusion‐associated circulatory overload (TACO) is a pulmonary transfusion complication and a leading cause of transfusion‐related morbidity and mortality. Volume overload and rising hydrostatic pressure as a consequence of transfusion are seen as the central pathway leading to TACO. A possible preventative measure for TACO could be the use of low‐volume blood products like volume‐reduced lyophilized plasma. We hypothesize that volume‐reduced lyophilized plasma decreases circulatory overload leading to a reduced pulmonary capillary pressure and can therefore be an effective strategy to prevent TACO. Materials and Methods A validated two‐hit animal model in rats with heart failure was used. Animals were randomized to receive 4 units of either solvent‐detergent pooled plasma (SDP) as control, standard volume lyophilized plasma (LP‐S) or hyperoncotic volume‐reduced lyophilized plasma (LP‐VR). The primary outcome was the difference between pre‐transfusion and post‐transfusion left ventricular end‐diastolic pressure (ΔLVEDP). Secondary outcomes included markers for acute lung injury. Results LVEDP increased in all randomization groups following transfusion. The greatest elevation was seen in the group receiving LP‐VR (+11.9 mmHg [5.9–15.6]), but there were no significant differences when compared to groups receiving either LP‐S (+6.3 mmHg [2.9–13.4], p = 0.29) or SDP (+7.7 mmHg [4.5–10.5], p = 0.55). There were no significant differences in markers for acute lung injury, such as pulmonary wet/dry weight ratios, lung histopathology scores or PaO2/FiO2 ratio between the three groups. Conclusion Transfusion with hyperoncotic volume‐reduced plasma did not attenuate circulatory overload compared to standard volume plasma and was therefore not an effective preventative strategy for TACO in this rat model.

CE: Recognizing Transfusion-Associated Circulatory Overload

“…Why TACO occurs is not completely understood, though it is known to result from the pulmonary edema that develops as a result of increased hydrostatic pressure following transfusion. 26 That is, there is respiratory distress from fluid buildup in the lungs, but it has a cardiac cause, typically some type of left ventricular dysfunction. Recent research by Bulle and colleagues indicates that TACO follows elements that increase risk of TACO include verbal orders (which suggest the physician has not reviewed the patient's medical record or other TACO risk factors before delivering the order), transfusing more than a single unit of red blood cells, rapid rates of transfusion, and improper timing of preemptive diuretics to prevent TACO.…”

“…Why TACO occurs is not completely understood, though it is known to result from the pulmonary edema that develops as a result of increased hydrostatic pressure following transfusion 26. That is, there is respiratory distress from fluid buildup in the lungs, but it has a cardiac cause, typically some type of left ventricular dysfunction.…”