Circadian patterns in transfusion-associated circulatory overload

To examine if transfusion-associated circulatory overload (TACO) shows a circadian pattern.

Non-urgent transfusions often take place during the night-time. This interferes with patient rest and patient monitoring. Also, transfusion reactions like TACO may be more likely during the night for pathophysiologic reasons.

Using New Zealand haemovigilance and transfusion data for the three-year period between January 2022 and December 2024, we compared the daytime and night-time rates of TACO and two other transfusion reactions (allergic reactions and transfusion-associated hypotension, TAH).

A quarter of transfusion episodes happened during the night-time. The night-time TACO rate was twice the daytime rate (p = <0.0001). This was also seen in males alone (p = <0.0001), but not in females. With allergic reactions, the daytime and night-time rates were similar. With TAH, it appeared to be higher, but our TAH numbers are small.

The night-time TACO rate was higher than the daytime rate. As with cardiogenic acute pulmonary edema and other cardio- and cerebro-vascular conditions which are more frequent at night, this may involve biological clocks, external stressors (e.g. recumbency and transfusion), and individual risk factors. This is yet another reason to avoid overnight transfusions unless urgently needed.