American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial step in managing transfusion-associated circulatory overload?

1. Continue transfusion

2. Administer intravenous fluids

3. Discontinue transfusion

4. Increase transfusion rate

The correct answer is: Discontinue transfusion

Discontinuing the transfusion is the critical initial step in managing transfusion-associated circulatory overload (TACO). TACO occurs when there is an excess volume of blood or blood products transfused, resulting in fluid overload that can lead to respiratory distress, hypertension, and pulmonary edema. The immediate response involves stopping the transfusion to prevent further volume increase in the patient's circulatory system. This action helps alleviate symptoms and prevents the condition from worsening. After stopping the transfusion, the healthcare provider can focus on supportive measures such as administering diuretics to manage fluid overload and monitoring the patient's vital signs and clinical status. In this context, continuing the transfusion would exacerbate the patient's condition, while administering intravenous fluids would contribute further to volume overload. Increasing the transfusion rate would similarly worsen the situation, leading to greater risks of severe complications associated with fluid overload.