The association of fever with transfusion-associated circulatory overload.

BackgroundFever is described in transfusion-associated circulatory overload (TACO), reflecting either comprehensive haemovigilance or an inflammatory pathobiology (such as congestion-associated atheroma disruptions). MethodsHospital haemovigilance data (1/1/2010-31/12/2012) were reviewed for TACO cases (frequency and mode of referral). TACO with or without fever (TACO+F/-F) was examined for its association with patient age (as a surrogate for atheroma burden) and product age (as a surrogate for storage-related pyrogens). Fever in allergic transfusion reactions was also compared. ResultsOf 972 reactions, 107 suspected cases of TACO (11%) were seen. TACO+F vs. TACO-F occurred in 421 vs. 579%, respectively. TACO+F cases were discovered in referrals to investigate either a fever (in 471%) or dyspnoea (in 529%). Among TACO+F cases, 244% had already been febrile, whereas 756% exhibited a new reaction-associated fever. After excluding preexisting fevers, TACO+F occurred in 318% of TACO, compared with 82% of allergic reactions with fever, for an odds ratio of 52 (29-94 [95% CI]), P < 0001. TACO+F/TACO-F showed no difference in median host age (69 vs. 64 years, P = 03), RBC age (22 days +F/-F, P = 09) or severity. ConclusionTransfusion-associated circulatory overload disproportionately exhibits fever compared with allergic reactions. However, TACO+F did not associate with patient or product age, nor reflect severity. To better understand TACO+F, the fever-congestion sequence merits attention. Further study is needed to see whether TACO+F occurs as reproducibly elsewhere, and in association with atherosclerosis in a better characterized cohort.