title: The association of fever with transfusion-associated circulatory overload.
abstract: BACKGROUND
  Fever is described in transfusion-associated circulatory overload (TACO), reflecting either comprehensive haemovigilance or an inflammatory pathobiology (such as congestion-associated atheroma disruptions).
  
  
  METHODS
  Hospital 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.
  
  
  RESULTS
  Of 972 reactions, 107 suspected cases of TACO (11%) were seen. TACO+F vs. TACO-F occurred in 42·1 vs. 57·9%, respectively. TACO+F cases were discovered in referrals to investigate either a fever (in 47·1%) or dyspnoea (in 52·9%). Among TACO+F cases, 24·4% had already been febrile, whereas 75·6% exhibited a new reaction-associated fever. After excluding preexisting fevers, TACO+F occurred in 31·8% of TACO, compared with 8·2% of allergic reactions with fever, for an odds ratio of 5·2 (2·9-9·4 [95% CI]), P < 0·001. TACO+F/TACO-F showed no difference in median host age (69 vs. 64 years, P = 0·3), RBC age (22 days +F/-F, P = 0·9) or severity.
  
  
  CONCLUSIONS
  Transfusion-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.
authors.affiliation: Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]), Laboratory Medicine Program (LMP), University Health Network (UHN), Toronto, ON, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Parmar
authors.affiliation: Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]), Laboratory Medicine Program (LMP), University Health Network (UHN), Toronto, ON, Canada.|Department of Medical Oncology & Hematology (DMOH), University Health Network (UHN), Toronto, ON, Canada.|Department of Laboratory Medicine - Pathobiology (LMP), Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Department of Medicine - Division of Hematology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative, Toronto, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Pendergrast
authors.affiliation: Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]), Laboratory Medicine Program (LMP), University Health Network (UHN), Toronto, ON, Canada.|Department of Laboratory Medicine - Pathobiology (LMP), Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative, Toronto, ON, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Lieberman
authors.affiliation: Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]), Laboratory Medicine Program (LMP), University Health Network (UHN), Toronto, ON, Canada.|Department of Laboratory Medicine - Pathobiology (LMP), Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative, Toronto, ON, Canada.|Department of Clinical Pathology, Blood & Tissue Bank Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]), Laboratory Medicine Program (LMP), University Health Network (UHN), Toronto, ON, Canada.|Department of Laboratory Medicine - Pathobiology (LMP), Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative, Toronto, ON, Canada.|Department of Clinical Pathology, Blood & Tissue Bank Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Callum
authors.affiliation: Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]), Laboratory Medicine Program (LMP), University Health Network (UHN), Toronto, ON, Canada.|Department of Medical Oncology & Hematology (DMOH), University Health Network (UHN), Toronto, ON, Canada.|Department of Laboratory Medicine - Pathobiology (LMP), Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Department of Medicine - Division of Hematology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative, Toronto, ON, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Cserti-Gazdewich
mesh_terms: D000367:Age Factors; D016208:Databases, Factual; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D013997:Time Factors; D065227:Transfusion Reaction
keywords: blood components; blood safety; hemovigilance; transfusion medicine; transfusion reactions