Febrile transfusion‐associated circulatory overload in adult oncology patients

Background and Objectives Transfusion‐associated circulatory overload (TACO) is the leading cause of transfusion‐related morbidity and mortality. We evaluated the incidence of TACO and its association with new fever (HOT‐TACO) at a comprehensive cancer centre. Materials and Methods Retrospective review of haemovigilance data (July 2019–October 2020) identified 100 possible to definite TACO cases. TACO cases were classified as HOT‐TACO or regular TACO, differentiated by an association with new‐onset fever. Both groups were assessed by type, age of blood products involved, reaction severity, cancer diagnosis and white blood cells (WBC) counts. Results Among 1382 transfusion reactions in a 15‐month period, 111 cases of TACO (8%) were diagnosed. A total of 100 adult TACO cases were included in this study; 16% of them were HOT‐TACO cases. The median WBC counts pre‐ and post‐transfusion in the HOT‐TACO versus regular‐TACO group were not statistically different (pre‐ 5.400 vs. 2.050, p = 0.19; post 4.100 vs. 1.900, p = 0.45). However, the HOT‐TACO group had a 2.7‐fold higher pre‐WBC and a 2.2‐fold higher post‐WBC when compared with the regular TACO group. There were no significant differences in age of the blood products involved, red blood cell (RBC) age (median 12 days, p = 0.34), platelet age (single donor platelet [SDP]/random donor platelet [RDP] unit) (median 5/5 days, p = 0.32/ p = 0.72) or reaction severity between groups. Conclusion We found an association of TACO and new fever in 16% of cases compared with 32% reported in a non‐exclusive oncological setting. Findings are likely related to impaired immune response present in cancer patients associated with immunosuppression. Our findings support that fever should not be used to distinguish transfusion‐related acute lung injury (TRALI) from TACO.