title: N-terminal pro-brain natriuretic peptide is a useful diagnostic marker for transfusion-associated circulatory overload.
abstract: BACKGROUND
  Transfusion-associated circulatory overload (TACO) can be difficult to diagnose and distinguish from transfusion-related acute lung injury (TRALI), but is a relatively common complication that occurs when increases in blood volume overwhelm the cardiovascular system. Brain natriuretic peptide (BNP) has been shown to be a functional marker for TACO. N-terminal pro-brain natriuretic peptide (NT-proBNP) is another marker that could be more helpful than BNP since it has a longer half-life in circulation and is also much more stable in laboratory samples. In this study, whether NT-proBNP is a useful diagnostic marker for TACO was evaluated.
  
  
  METHODS
  Forty patients were enrolled into a case-control study (16 patients with TACO and 24 control patients) and had pre- and posttransfusion NT-proBNP concentrations evaluated from submitted type-and-screen blood samples.
  
  
  RESULTS
  The sensitivity of elevated posttransfusion NT-proBNP to diagnose TACO was 93.8 percent, the specificity was 83.8 percent, and the accuracy was 87.5 percent. Elevated posttransfusion NT-proBNP is the only independent variable for the diagnosis of TACO based on multivariate logistic regression.
  
  
  CONCLUSIONS
  NT-proBNP is both a sensitive and a specific marker for TACO and can be helpful in confirming transfusion associated fluid overload. This study also demonstrates that many patients who experience TACO may already be in a state of excess volume. Clinicians should be aware that many asymptomatic patients have excess fluid and transfusion may cause these patients to become symptomatic.
authors.affiliation: Transfusion Medicine Division and Clinical Chemistry Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. atobian1@jhmi.edu
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Sokoll
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tisch
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.forename: Hua
authors.initials: H
authors.lastname: Shan
mesh_terms: D015415:Biomarkers / Q000097:blood; D001775:Blood Circulation; D005260:Female; D006402:Hematologic Diseases / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012372:ROC Curve; D065227:Transfusion Reaction
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain