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Circadian patterns in transfusion-associated circulatory overload.

Krishna G Badami1, Anna Y Zhou1

  • 1Clinical Department, New Zealand Blood Service, Addington, Christchurch, New Zealand.

Transfusion Medicine (Oxford, England)
|March 9, 2026
PubMed
Summary

Transfusion-associated circulatory overload (TACO) occurs twice as often at night compared to the day. This finding suggests biological clocks may influence TACO risk, supporting avoidance of non-urgent overnight transfusions.

Keywords:
circadian variationovernight transfusionstransfusion‐associated circulatory overload

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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.