Johanna C Wiersum-Osselton1, Barbee Whitaker2, Sharran Grey3, Kevin Land4, Gabriela Perez5, Srijana Rajbhandary6, Chester Andrzejewski7, Paula Bolton-Maggs8, Harriet Lucero9, Philippe Renaudier10, Pierre Robillard11, Matilde Santos12, Martin Schipperus13. 1. Transfusion and Transplantation Reactions in Patients Hemovigilance and Biovigilance Office, Leiden, Netherlands. 2. Office of Biostatistics and Epidemiology, US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA. 3. Bolton National Health Service Foundation Trust, Greater Manchester, UK; Serious Hazards of Transfusion, Manchester Blood Centre, Manchester, UK. 4. Vitalant, Tempe, AZ, USA. 5. Department of Research, AABB, Bethesda, MD, USA. 6. Department of Research, AABB, Bethesda, MD, USA. Electronic address: srajbhandary@aabb.org. 7. System Blood Banking and Transfusion/Apheresis Medicine Services, Department of Pathology, University of Massachusetts Medical School-Baystate, Baystate Health/Baystate Medical Center, Springfield, MA, USA. 8. Serious Hazards of Transfusion, Manchester Blood Centre, Manchester, UK. 9. The Christie National Health Service Foundation Trust, Manchester, UK. 10. Service d'Hématologie, Hôpital Pierre Zobda-Quitman, Fort-de-France, Cedex, Martinique. 11. Héma-Québec, Saint-Laurent, QC, Canada. 12. Instituto Português de Sangue e da Transplantação, Lisbon, Portugal. 13. Transfusion and Transplantation Reactions in Patients Hemovigilance and Biovigilance Office, Leiden, Netherlands; Haga Teaching Hospital, Leyweg, The Hague, Netherlands.
Abstract
BACKGROUND: Transfusion-associated circulatory overload (TACO) is a major cause of transfusion-related morbidity and mortality in countries with well developed transfusion services. The International Society of Blood Transfusion, the International Haemovigilance Network, and AABB (formerly American Association of Blood Banks), have developed and validated a revised definition of TACO. METHODS: International Haemovigilance Network-member haemovigilance systems (Australia, Austria, Denmark, Finland, Greece, India, Ireland, Italy, Japan, Malta, Netherlands, New Zealand, Norway, Slovenia, United Kingdom and United States) provided cases of respiratory complications categorised by their systems, including clinical parameters listed in the 2017 draft definition (part 1). Individual transfusion professionals were then invited to assess 24 case descriptions according to the draft definition (part 2). Positive and negative agreement and inter-rater agreement (κ) were calculated. Based on validation results, cases were reanalysed and slight adjustments made to yield the final 2018 TACO definition. FINDINGS: In part 1, 16 (44%) of 36 haemovigilance systems provided 178 cases, including 126 TACO cases. By use of the 2018 definition, 96 (76%) of 126 cases of TACO were in positive agreement. 19 (37%) of 52 cases were recognised as non-TACO respiratory complications. In part 2 (47 experts from 20 countries), moderate all-case agreement (κ=0·43) and TACO-specific agreement (κ=0·54) were observed. Excluding cases missing some clinical information (eg, N terminal pro-brain natriuretic peptide, distinctive chest x-ray findings, and relationship with existing respiratory co-morbidities like pneumonia and chronic obstructive pulmonary disease) improved all-case agreement to κ=0·50 (moderate) and κ=0·65 (good) for TACO cases. INTERPRETATION: The two-part validation exercise showed that the revised 2018 TACO surveillance case definition captures 76% of cases endorsed as TACO by participating haemovigilance systems. This definition can become the basis for internationally consistent surveillance reporting and contribute towards increased awareness and mitigation of TACO. Further research will require reporting more complete clinical information to haemovigilance systems and should focus on improved distinction between TACO and other transfusion respiratory complications. FUNDING: International Society of Blood Transfusion, International Haemovigilance Network, and AABB.
BACKGROUND: Transfusion-associated circulatory overload (TACO) is a major cause of transfusion-related morbidity and mortality in countries with well developed transfusion services. The International Society of Blood Transfusion, the International Haemovigilance Network, and AABB (formerly American Association of Blood Banks), have developed and validated a revised definition of TACO. METHODS: International Haemovigilance Network-member haemovigilance systems (Australia, Austria, Denmark, Finland, Greece, India, Ireland, Italy, Japan, Malta, Netherlands, New Zealand, Norway, Slovenia, United Kingdom and United States) provided cases of respiratory complications categorised by their systems, including clinical parameters listed in the 2017 draft definition (part 1). Individual transfusion professionals were then invited to assess 24 case descriptions according to the draft definition (part 2). Positive and negative agreement and inter-rater agreement (κ) were calculated. Based on validation results, cases were reanalysed and slight adjustments made to yield the final 2018 TACO definition. FINDINGS: In part 1, 16 (44%) of 36 haemovigilance systems provided 178 cases, including 126 TACO cases. By use of the 2018 definition, 96 (76%) of 126 cases of TACO were in positive agreement. 19 (37%) of 52 cases were recognised as non-TACO respiratory complications. In part 2 (47 experts from 20 countries), moderate all-case agreement (κ=0·43) and TACO-specific agreement (κ=0·54) were observed. Excluding cases missing some clinical information (eg, N terminal pro-brain natriuretic peptide, distinctive chest x-ray findings, and relationship with existing respiratory co-morbidities like pneumonia and chronic obstructive pulmonary disease) improved all-case agreement to κ=0·50 (moderate) and κ=0·65 (good) for TACO cases. INTERPRETATION: The two-part validation exercise showed that the revised 2018 TACO surveillance case definition captures 76% of cases endorsed as TACO by participating haemovigilance systems. This definition can become the basis for internationally consistent surveillance reporting and contribute towards increased awareness and mitigation of TACO. Further research will require reporting more complete clinical information to haemovigilance systems and should focus on improved distinction between TACO and other transfusion respiratory complications. FUNDING: International Society of Blood Transfusion, International Haemovigilance Network, and AABB.
Authors: Robert B Klanderman; Marije Wijnberge; Joachim J Bosboom; Joris J T H Roelofs; Dirk de Korte; Robin van Bruggen; Markus W Hollmann; Margreeth B Vroom; Denise P Veelo; Nicole P Juffermans; Bart F Geerts; Alexander P J Vlaar Journal: Vox Sang Date: 2021-08-15 Impact factor: 2.996
Authors: Pearl Toy; Mark R Looney; Mark Popovsky; Miodrag Palfi; Gösta Berlin; Catherine E Chapman; Paula Bolton-Maggs; Michael A Matthay Journal: Ann Am Thorac Soc Date: 2022-05
Authors: Nicholas A Bosch; Anica C Law; Jacob Bor; Laura C Myers; Nareg H Roubinian; Vincent X Liu; Allan J Walkey Journal: Ann Am Thorac Soc Date: 2022-07
Authors: Alexander P J Vlaar; Pearl Toy; Mark Fung; Mark R Looney; Nicole P Juffermans; Juergen Bux; Paula Bolton-Maggs; Anna L Peters; Christopher C Silliman; Daryl J Kor; Steve Kleinman Journal: Transfusion Date: 2019-04-16 Impact factor: 3.157
Authors: Robert B Klanderman; Joachim J Bosboom; Adrie A W Maas; Joris J T H Roelofs; Dirk de Korte; Robin van Bruggen; Jaap D van Buul; Coert J Zuurbier; Denise P Veelo; Markus W Hollmann; Margreeth B Vroom; Nicole P Juffermans; Bart F Geerts; Alexander P J Vlaar Journal: Transfusion Date: 2019-11-07 Impact factor: 3.157