title: Hemotherapy bedside biovigilance involving vital sign values and characteristics of patients with suspected transfusion reactions associated with fluid challenges: can some cases of transfusion-associated circulatory overload have proinflammatory aspects?
abstract: BACKGROUND
  Monitoring of patients' vital sign values (VSVs) during hemotherapy may have an important role in the recognition and mitigation of transfusion-associated circulatory overload (TACO). Knowledge regarding VSVs and other patient characteristics in bedside-reported TACO or fluid challenge-suspected transfusion reactions (TACO/FC-STRs) is limited.
  
  
  METHODS
  We performed a retrospective observational cohort study of cases of uncomplicated red blood cell (RBC) transfusions (UCTs) and reported suspected transfusion reaction (STR) cases investigated by our hospital's transfusion medicine service (TMS) from January 1, 2005, to February 29, 2008, using data obtained from TMS consult reports and quality improvement databases examining VSVs and patient characteristics in TACO/FC-STRs.
  
  
  RESULTS
  The frequency of TACO/FC-STRs was 0.19% per all RBC units transfused (1:530 units transfused). Both clinically and statistically (p≤0.05) significant changes were encountered in all VSVs in patients experiencing TACO/FC-STRs either at the 15-minute time interval or at the end-of-transfusion time points. Measured and derived VSVs related to the patients' blood pressure in the peritransfusion period were consistently increased. Approximately two-thirds of TACO/FC-STR patients also exhibited inflammatory related signs and symptoms at STR bedside presentation. Differences (all p≤0.050) between UCT and TACO/FC-STR cohorts were seen for patient mean weights (80 kg vs. 72 kg), mean minutes to transfusion completion (121 min vs. 83 min), and mean storage age of suspected sentinel RBC unit (22.5 days vs. 25.2 days).
  
  
  CONCLUSIONS
  Trend monitoring of peritransfusion VSVs, especially blood pressures, may aid in the bedside recognition of TACO/FC-STRs. A subset of these patients may also present with febrile and/or inflammatory signs and symptoms.
authors.affiliation: Transfusion Medicine Services, Department of Pathology, Surgical Services Administration, Baystate Medical Center, Baystate Health, Springfield, Massachusetts 01199, USA. chester.andrzejewski@bhs.org
authors.forename: Chester
authors.initials: C
authors.lastname: Andrzejewski
authors.forename: Mark A
authors.initials: MA
authors.lastname: Popovsky
authors.forename: Theresa C
authors.initials: TC
authors.lastname: Stec
authors.forename: Jean
authors.initials: J
authors.lastname: Provencher
authors.forename: Lynne
authors.initials: L
authors.lastname: O'Hearn
authors.forename: Paul
authors.initials: P
authors.lastname: Visintainer
authors.forename: Jay
authors.initials: J
authors.lastname: Steingrub
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001787:Blood Group Incompatibility / Q000175:diagnosis* / Q000276:immunology; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion / Q000379:methods / Q000592:standards; D001810:Blood Volume / Q000502:physiology*; D016208:Databases, Factual; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000276:immunology; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D056152:Respiratory Rate / Q000502:physiology; D012189:Retrospective Studies; D065227:Transfusion Reaction; D055986:Vital Signs / Q000502:physiology*