Transfusion reaction - Increase BP - Guideliness

[seraph44]

Hi everyone,

I'm trying to get some feedback on transfusion reactions. If you have a dialysis patient with a base line BP of 130/54 and they're trying to get in a unit during the dialysis treatment in 40  minutes. This causes the BP to clime up to 170/75; most likely due to the rapid transfusion right? Would this be considered TACO if the patient doesn't present any symptoms of decreased pulse ox or dyspnea, etc...?

Another question is, if the base line BP of a patient is progressively rising during a 2 hour transfusion to the point that the final BP is significantly elevated when compared to the baseline but not when compared to the others, would this be indicative of TACO? Does your facility count it suspicious if there is significant difference from the baseline or significant difference from the previous vitals. I would add that in my personal opinion I do not consider the increase in BP alone to indicate TACO, but if you have no other documentation in the patient chart or transfusion record, you assume the nurse did not assess the patient right? How does your facility handle these situations currently?

Thanks,

Serafin

[jojo808]

Most references do not use the single symptom of increased BP to indicate a TACO reaction. They usually list a variety of symptoms in which a combination of 3 or more of the following need to be present: 

Increased BP, Respiratory distress (dyspnea), Acute or worsening pulmonary edema via xray, tachycardia, jugular vein distension, increased BNP (brain natriuretic peptide), response to diuretics......

It's up to your facility to decide what kind of criteria you want in your policy. In any case I would think this is important to note in the patient's file since the patient receives dialysis and would probably need to be transfused sitting upright and very slowly if this is indeed a TACO or TACO-like reaction for future transfusions. 

[Neil Blumberg]

TACO is congestive heart failure.  Hypertension is not congestive heart failure, but may be of concern.  Transient rises in the range of 170 to 200 that last minutes, not hours, are usually not of concern.  That can happen with rapidly climbing a flight of stairs.