American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the management for Transfusion-Associated Circulatory Overload?

1. Increased transfusion rate

2. Transfusion discontinuation and diuretic therapy

3. Immediate blood transfusion

4. Administration of corticosteroids

The correct answer is: Transfusion discontinuation and diuretic therapy

Transfusion-Associated Circulatory Overload (TACO) occurs when the volume of blood transfused exceeds the capacity of the heart to handle it, leading to pulmonary edema and respiratory distress. The management for TACO typically involves stopping the transfusion immediately to prevent further volume overload. Diuretic therapy is an essential step in managing TACO as it helps to alleviate fluid overload by promoting diuresis, thus helping to relieve symptoms such as dyspnea and edema. The combination of discontinuing the transfusion and administering diuretics addresses both the immediate need to stop delivering more fluid into an already overloaded system and the need to manage the excess fluid that is causing the circulatory overload. Other interventions, such as supportive care with oxygen and potentially volume resuscitation if the patient is hypotensive, may also be necessary, but the primary management strategy focuses on stopping the transfusion and using diuretics. The other options do not adequately address the problem of fluid overload associated with TACO. Increasing the transfusion rate would likely worsen the condition, while immediate blood transfusion would not be appropriate. Lastly, administering corticosteroids does not directly treat the circulatory overload and is not a standard approach for managing TACO.