Circadian patterns in transfusion-associated circulatory overload

Area of Science:

• Medical research
• Hematology
• Circadian biology

Background:

• Non-urgent transfusions are frequently administered overnight, disrupting patient rest and monitoring.
• Pathophysiological factors may increase the likelihood of transfusion reactions, such as TACO, during nighttime hours.

Purpose of the Study:

• To investigate whether transfusion-associated circulatory overload (TACO) exhibits a circadian pattern.
• To compare the incidence of TACO during daytime versus nighttime transfusions.

Main Methods:

• Analysis of New Zealand haemovigilance and transfusion data from January 2022 to December 2024.
• Comparison of daytime and nighttime rates for TACO, allergic reactions, and transfusion-associated hypotension (TAH).

Main Results:

• Approximately 25% of transfusion episodes occurred overnight.
• The nighttime TACO rate was double the daytime rate (p < 0.0001), particularly in males.
• Daytime and nighttime rates for allergic reactions were similar; TAH rates were higher at night but based on small numbers.

Conclusions:

• Nighttime transfusions are associated with a significantly higher rate of TACO compared to daytime transfusions.
• The circadian pattern of TACO may be influenced by biological clocks, external stressors like recumbency and transfusion, and individual risk factors.
• These findings reinforce the recommendation to avoid non-urgent overnight transfusions.