Transfusion associated circulatory overload audit 2017

Key objectives

  • A comparison of practice against BCSH, SHOT and NICE recommendations
  • A greater understanding of how patients at risk of TACO are managed
  • The publication of recommendations for best practice
  • The production and distribution of tools to aid local practice improvement

What did we audit?

We audited people aged 60 years or older who had received a red cell transfusion in March or April 2017.

Who took part?

We audited 4580 patients from 157 sites over 2 months in 2017. 2461 inpatient transfusions and 2113 outpatient transfusions. Median age 78 years.

What did we find?

Assessing risk of TACO

89% of audited inpatients had at least one additional risk factor for TACO apart from age, the most common reason was hypoalbuminaemia (52%). Only 20.5% of inpatients had risk assessment for TACO performed and documented in the notes. Only 43% of outpatients were seen by the person prescribing the blood in the week prior to transfusion.

Pre-emptive measures to minimise risk

29% of inpatients with a fluid balance recorded were more than 1000mls positive prior to the transfusion

fluid balance.png

Diagnosis and treatment of TACO

4.3% of inpatients developed acute or worsening respiratory distress

1.7% of outpatients were re-admitted within 24 hours of the transfusion, of which 20% were readmitted with worsening respiratory symptoms.

Reporting of TACO 

33% of inpatients diagnosed with TACO by the hospital were reported to SHOT. 

Tools to help improve practice

Please cite as:

The TACO Audit Working Group, on behalf of the National Comparative Audit in Blood Transfusion (NCABT) Steering Group. The 2017 audit of Transfusion Associated Circulatory Overload (2018).


S Morton, J Grant-Casey, P Bolton-Maggs, U Tandon, J Addison, A Bartholomew, L Estcourt. Skating on Thin Ice: National Audit of TACO Demonstrates Poor Recognition of Risk Factors. Blood 2017 130:2406; Abstract