ISSN 2997-1036
International Journal of Hematology | Vol. 4, No. 7, July 2013 | pp. 49–56
DOI: 10.46882/2013/IJH/000043
Review Article
Title: Transfusion-associated circulatory overload: Evolving physiological mechanisms and preventive strategy guidelines
Names of Authors: M. A. Bello¹, O. R. Eze²
Authors’ Affiliations: ¹Department of Haematology, Aminu Kano Teaching Hospital, Kano, Nigeria; ²Department of Pathology, University of Benin, Benin City, Nigeria
Abstract: Transfusion-associated circulatory overload is a leading cause of transfusion-related morbidity and mortality in acute hospital settings. This review synthesizes current insights into its pathophysiology, distinguishing it from transfusion-related acute lung injury by examining volume expansion kinetics, hydrostatic pressure elevations, and underlying cardiopulmonary vulnerability. High-risk patient characteristics include advanced age, chronic kidney disease, severe baseline anemia, and positive fluid balance states. Clinical identification relies on respiratory distress emerging within 6 hours of transfusion, accompanied by elevated brain natriuretic peptide levels (> 1.5 times baseline) and acute hypertension. Prevention strategies emphasize risk stratification prior to blood administration. Utilizing a slow infusion rate (1.0 to 1.5 ml/kg/hour) and implementing proactive prophylactic diuretic regimens (e.g., 20 mg to 40 mg intravenous furosemide) significantly reduce pulmonary hydrostatic pressure. Splitting multi-unit blood requests into single units with mandatory reassessments further minimizes volume overload. This review outlines an operational nursing and medical workflow checklist designed to optimize bedside surveillance and reduce preventable circulatory distress in high-risk transfusion recipients.
Keywords: Transfusion-associated circulatory overload, hydrostatic pressure, brain natriuretic peptide, fluid balance, blood safety
Manuscript Timeline: Received: April 11, 2013; Revised: May 20, 2013; Accepted: June 12, 2013; Published: July 16, 2013