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Abstract Background Reported incidence of blood transfusion reactions (TR) varies greatly. Objective To prospectively evaluate the incidence of acute TRs in dogs receiving allogenic blood products, using consensus definitions, and to assess factors associated with TRs. Animals Dogs (n = 858) administered allogenic blood products (n = 1542) between March and November 2022. Methods Prospective, multicenter surveillance study occurring in referral hospitals in the United States, United Kingdom, and Australia recording TRs in dogs administered blood products as defined by the consensus guidelines published by The Association of Veterinary Hematology and Transfusion Medicine in 2021. Results The incidence of acute TR was 8.9% (95% CI 7.0‐11.1) for packed red blood cells (pRBCs) and 4.5% (95% CI 2.9‐6.6) for plasma products. The most frequently reported TRs were febrile nonhemolytic TRs (FNHTR; 4%, 95% CI 2.8‐5.5) when administering pRBCs and allergic TRs (3.2%, 95% CI 1.80‐5.10) when administering plasma products. A higher dose of pRBC (adjusted odds ratio [aOR] 1.04 [95% CI 1.00‐1.08]) was associated with a higher odds of TR. Administration of pRBCs stored for longer than 28 days was associated with higher odds of FNHTR (aOR 4.10 [95% CI 1.58‐10.65]) and acute hemolytic TR (AHTR; OR 15.2 [95% CI 3.35‐68.70]) when compared with pRBCs stored for 14 days or fewer. Leukoreduction of pRBC was not associated with lower odds of developing a TR (OR 1.47 [95% CI 0.89‐2.42]). Conclusions and Clinical Importance Clinicians should be mindful of the age and dose of pRBC prescribed to dogs.

Background: Reported incidence of blood transfusion reactions (TR) varies greatly. Objective: To prospectively evaluate the incidence of acute TRs in dogs receiving allogenic blood products, using consensus definitions, and to assess factors associated with TRs. Animals: Dogs (n = 858) administered allogenic blood products (n = 1542) between March and November 2022. Methods: Prospective, multicenter surveillance study occurring in referral hospitals in the United States, United Kingdom, and Australia recording TRs in dogs administered blood products as defined by the consensus guidelines published by The Association of Veterinary Hematology and Transfusion Medicine in 2021. Results: The incidence of acute TR was 8.9% (95% CI 7.0‐11.1) for packed red blood cells (pRBCs) and 4.5% (95% CI 2.9‐6.6) for plasma products. The most frequently reported TRs were febrile nonhemolytic TRs (FNHTR; 4%, 95% CI 2.8‐5.5) when administering pRBCs and allergic TRs (3.2%, 95% CI 1.80‐5.10) when administering plasma products. A higher dose of pRBC (adjusted odds ratio [aOR] 1.04 [95% CI 1.00‐1.08]) was associated with a higher odds of TR. Administration of pRBCs stored for longer than 28 days was associated with higher odds of FNHTR (aOR 4.10 [95% CI 1.58‐10.65]) and acute hemolytic TR (AHTR; OR 15.2 [95% CI 3.35‐68.70]) when compared with pRBCs stored for 14 days or fewer. Leukoreduction of pRBC was not associated with lower odds of developing a TR (OR 1.47 [95% CI 0.89‐2.42]). Conclusions and Clinical Importance: Clinicians should be mindful of the age and dose of pRBC prescribed to dogs. [ABSTRACT FROM AUTHOR]

Background and Objectives: Transfusion‐associated circulatory overload (TACO) and transfusion‐related acute lung injury (TRALI) are serious adverse transfusion reactions. Standardized surveillance definitions are important to ensure consistent reporting of cases. Recently, revised definitions have been developed for TACO and TRALI, the latter of which has not yet been widely implemented. This study aimed to assess the impact of the new TACO and TRALI definitions on haemovigilance reporting. Materials and Methods: The Australian Red Cross Lifeblood Adverse Transfusion Reaction database was accessed to identify all cases of suspected or confirmed TACO and TRALI referred from 1 July 2015 to 30 June 2019. Cases were assessed against both the former and new definitions and the results were compared. Results: A total of 73 cases were assessed. There were 48 TACO cases identified. Only 26 of 48 cases strictly met the former 2011 International Society of Blood Transfusion (ISBT) definition of TACO; 6 cases did not meet the definition and 16 cases lacked sufficient clinical details. In comparison, 46 cases met the revised 2018 ISBT definition, with only 2 cases having insufficient details. There were 24 cases of TRALI according to the existing 2004 Canadian Consensus Conference (CCC) definition compared with 25 cases according to the proposed 2019 revised definition. Conclusion: The revised TACO definition captured more cases than the former definition. No significant differences were observed in the number of TRALI cases under the proposed new definition. This is the first study to provide validation data for the revised TRALI definition. [ABSTRACT FROM AUTHOR]

Purpose: To assess the long-term outcome of graft insertion by taco technique through a 2.8-mm clear corneal incision in patients undergoing Descemet's stripping automated endothelial keratoplasty (DSAEK).Methods: This is a retrospective interventional case series of 77 eyes of 75 patients who underwent DSAEK in a tertiary eye hospital. The DSAEK donor grafts were folded to an uneven 70/30 taco and held at a single point using Utrata forceps. All insertions were through a 2.8-mm clear corneal incision except the two aphakic patients requiring combined SFIOL implantation. All patients underwent a comprehensive eye examination preoperatively and were followed up to 6 years postoperatively. Visual outcomes, graft clarity, and complications of all and endothelial cell loss in 22 patients with available postop specular microscopy were analyzed. Results: Overall, 59 (76.6%) had clear grafts until the final follow-up. Visual acuity improved in 48 (62.3%) from an average of 1.3 to 0.8 logMAR (P = 0.0001). Vision was maintained in seven and worsened in four eyes. Grafts failed in 18 (23.3%) eyes: seven (9%) were primary failures, two post rejection, four done for failed PK did not clear, four due to worsening of preexisting glaucoma, and one noncompliant failed eventually. Average endothelial cell density reduction was 26.3% (mean preop donor 2419 to postop 1779 cells/mm2; P = 0.000). Conclusion: Our study shows good long-term clinical outcome of DSAEK using Taco technique through a 2.8-mm clear corneal incision in a tertiary hospital.

Background and Objectives: Transfusion‐associated circulatory overload (TACO) is the primary cause of transfusion‐related mortality. Speed and volume of transfusion are major risk factors. The aim of this study was to investigate the interaction of red blood cell (RBC) transfusion speed and volume on the development of TACO. Materials and Methods: A validated model for TACO in anaemic Lewis rats with an acute myocardial infarction was used. The effect on pulmonary hydrostatic pressure of one, two or four units of packed RBCs transfused in either 30 or 60 min was evaluated (3.3–26.6 ml·kg−1·hr−1). Pulmonary capillary pressure was measured as left ventricular end‐diastolic pressure (LVEDP). Cardiac stress biomarkers atrial natriuretic‐peptide (ANP) and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) were measured 1‐h post‐transfusion. Results: Thirty animals were included (n = 5 per group). Transfusion of RBCs increased LVEDP in a volume‐dependent manner (ΔLVEDP [mmHg]: −0.95, +0.50, +6.26, p < 0.001). Fast transfusion increased overall ΔLVEDP by +3.5 mmHg and up to +11.8 mmHg in the four units' group (p = 0.016). Doubling transfusion speed increased ΔLVEDP more than doubling volume in the larger volume groups. No difference in ANP or NT‐proBNP were seen in high transfusion volume or groups. Conclusion: Transfusion volume dose‐dependently increased LVEDP, with speed of transfusion rapidly elevating LVEDP at higher transfusion volumes. ANP and NT‐proBNP were not impacted by transfusion volume or speed in this model. TACO is seen as purely volume overload, however, this study emphasizes that limiting transfusion speed, as a modifiable risk factor, might aid in preventing TACO. [ABSTRACT FROM AUTHOR]

Background: Blood transfusion is a life-saving procedure, but may cause adverse transfusion reactions (TRs). The reporting of TRs is often missed due to various reasons. The aim of this study was to determine the incidence of unreported acute TRs through active surveillance and to compare it with the incidence of passively reported TRs. Methods: This prospective observational study was done over a period of four months at a tertiary care hospital. A total of 500 consecutive transfusion episodes (TEs) in patients who had received blood component transfusions in the intensive care units were included in the study. Comprehensive data were collected from the blood bank records, patient records and through interviews with the attending clinical staff. The TEs were defined as all blood components issued to a single patient in 24 h. Results: The overall incidence of TRs was 1.8 % (9 cases), with 0.4 % (2 cases) being reported passively, while 1.4 % (7 cases) were identified during active surveillance. The transfusion-associated cardiac overload (TACO) had the highest incidence of 1.2 % (6 cases) in active surveillance. A single case of acute hemolytic transfusion reaction was also observed during active surveillance. The passively reported TRs were one allergic reaction and one febrile non-hemolytic transfusion reaction. Conclusion: Active surveillance of TRs provided an insight into the true incidence of TRs, which is higher when compared with the passively reported TRs. The TACO was found to have the highest incidence and not a single case was reported. There is a need to improve awareness regarding TR reporting.

Purpose: To assess the long-term outcome of graft insertion by taco technique through a 2.8-mm clear corneal incision in patients undergoing Descemet's stripping automated endothelial keratoplasty (DSAEK).Methods: This is a retrospective interventional case series of 77 eyes of 75 patients who underwent DSAEK in a tertiary eye hospital. The DSAEK donor grafts were folded to an uneven 70/30 taco and held at a single point using Utrata forceps. All insertions were through a 2.8-mm clear corneal incision except the two aphakic patients requiring combined SFIOL implantation. All patients underwent a comprehensive eye examination preoperatively and were followed up to 6 years postoperatively. Visual outcomes, graft clarity, and complications of all and endothelial cell loss in 22 patients with available postop specular microscopy were analyzed.Results: Overall, 59 (76.6%) had clear grafts until the final follow-up. Visual acuity improved in 48 (62.3%) from an average of 1.3 to 0.8 logMAR (P = 0.0001). Vision was maintained in seven and worsened in four eyes. Grafts failed in 18 (23.3%) eyes: seven (9%) were primary failures, two post rejection, four done for failed PK did not clear, four due to worsening of preexisting glaucoma, and one noncompliant failed eventually. Average endothelial cell density reduction was 26.3% (mean preop donor 2419 to postop 1779 cells/mm2; P = 0.000).Conclusion: Our study shows good long-term clinical outcome of DSAEK using Taco technique through a 2.8-mm clear corneal incision in a tertiary hospital. [ABSTRACT FROM AUTHOR]

Objectives: To review the new current diagnostic criteria of transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) from the literature while highlighting distinguishing features. We provide comprehensive understanding of the importance of hemovigilance and its role in appropriately identifying and reporting these potentially fatal transfusion reactions.Methods: A review of the English language literature was performed to analyze TACO and TRALI while providing further understanding of the rationale behind the historical underrecognition and underreporting.Results: Our review demonstrates the new 2018 and 2019 case definitions for TACO and TRALI, respectively. With more comprehensive diagnostic strategies, adverse transfusion events can be better recognized from mimicking events and underlying disease. In addition, there are mitigation strategies in place to help prevent complications of blood product transfusion, with emphasis on the prevention of TACO and TRALI.Conclusions: TACO and TRALI are potentially fatal adverse complications of blood transfusion. Both have been historically underrecognized and underreported due to poor defining criteria and overlapping symptomatology. Developing a thorough clinical understanding between these two entities can improve hemovigilance reporting and can contribute to risk factor identification and preventative measures. [ABSTRACT FROM AUTHOR]

Background: Transfusion‐associated circulatory overload (TACO) is an adverse reaction associated with a high risk of mortality. The actual incidence of TACO and hypertension associated with transfusion in Japan is unknown. Methods: A multicentre retrospective observational study was conducted across 23 institutions during the 1‐year period of 2016. Patients were included if they developed TACO or their blood pressure (either systolic or diastolic) increased by at least 30 mmHg during the transfusion. TACO was confirmed by the primary physicians and transfusion medicine teams and recorded in the data on passive surveillance, and additional data were extracted from electronic medical records. Results: In our patient cohort of 31 384 patients who underwent transfusion, the incidence of TACO and hypertension was 0·03% and 0·2%, respectively. However, 43% of the participating institutions didn't report any cases. When comparing risk factors between the TACO and hypertension groups, there were significant differences in comorbidities, such as abnormal findings on chest x‐ray. Significant differences between the two groups were observed post‐transfusion pulse rate, body temperature and oxygen saturation (P < 0·01). In the group of patients with hypertension, the level of BNP increased significantly after transfusion in 45% (5/11) of the patients. We identified 4 patients in the hypertension group who met the new ISBT's TACO criteria. Conclusion: Our study suggests that more attention should be given to TACO in Japan, particularly in terms of improving surveillance systems. For the early diagnosis of TACO, it is crucial to carefully monitor vital signs including blood pressure. [ABSTRACT FROM AUTHOR]

The pulmonary complications of transfusion (TACO, TRALI and TAD) are the leading cause of transfusion‐related mortality and major morbidity. Advance in this area is essential in improving transfusion safety. This review describes the drivers for change in haemovigilance practice, the influence of recent key publications and future directions. [ABSTRACT FROM AUTHOR]

Perioperative allogeneic blood product transfusion is common in lung transplantation and has various implications on the short- and long-term outcomes of lung recipients. This review summarizes the effect of transfusion on outcomes including primary graft dysfunction, chronic lung allograft dysfunction, and all-cause mortality. We outline known risk factors for increased transfusion requirement in lung transplantation and present current evidence regarding the effect of hemostatic agents including antifibrinolytics, recombinant factor VII, and prothrombin complex concentrates. Finally, we highlight the roles of point-of-care coagulation testing and goal-directed transfusion strategies in reducing transfusion requirements in lung transplantation. [ABSTRACT FROM AUTHOR]

Background and Objectives: Transfusion‐associated circulatory overload is a leading cause of transfusion‐related adverse events. The frequency and risks for transfusion‐associated circulatory overload in ambulatory haematology patients are not known. Materials and Methods: A retrospective cohort analysis of ambulatory patients transfused in a tertiary haematology centre, using medical records and an electronic transfusion database, was undertaken between January and December 2014. Variables studied included age, gender, diagnosis, heart failure, kidney disease and details of transfusions. Transfusion‐associated circulatory overload was defined according to proposed International Society of Blood Transfusion criteria. Patients with clinical evidence of hypervolaemia, not meeting the TACO definition and/or who were prescribed otherwise unscheduled diuretic agent, were collectively deemed to be at 'risk of clinically significant hypervolaemia' (ROCSH). Results: In the study period, 93 ambulatory patients (male = 49, female = 44, mean age = 75·89 ± 11·37 years) attended 715 transfusion encounters, totalling 1536 packed red cell units. No cases of TACO occurred whilst 'ROCSH' events occurred in 57/715 (8%) of transfusion encounters. In a univariate model, age was significantly associated with 'ROCSH', odds ratio = 1·05 (P = 0·017 95%, CI 1·01–1·09) and no factors were significant on multivariate analysis. Conclusions: Transfusion‐associated circulatory overload occurs infrequently haematology patients receiving ambulatory blood transfusions. To our knowledge, this is the first study to report on occurrence and risk factors for circulatory overload in ambulatory transfusions. This study provides vital baseline data for future prospective studies on this important aspect of haemovigilance. [ABSTRACT FROM AUTHOR]

Abstract A Mexican staple food prepared with corn "tortilla" (Zea mays L.) and common beans (Phaseolus vulgaris L.) is named as "taco". It was fermented in an in vitro colonic Simulator of Human Microbial Ecosystem (SHIME®) to evaluate the effect in short chain fatty acids (SCFA), ammonia production, and the growth of total presumptive counts for anaerobic bacteria, Lactobacillus spp., Bifidobacterium spp., Clostridium spp., and total coliforms in the three simulated reactors of the human colon. After two weeks of stabilization, the simulator was fed during 9 days with the mixture of 50 g of beans and 50 g of tortilla mixed with 100 mL of carbohydrate based medium. Every third day, samples were collected from the three simulated colon vessels for the corresponding analysis. The production of the SCFA was higher during the treatment period than the basal period in the three colon sections. The acetate was produced in higher concentration (191.9 mmol/L) than propionate and butyrate (29.1 and 55.0 mmol). During the treatment period, the higher molar ratio (%) for acetate, propionate, and butyrate were 84: 14: 24, respectively. The ammonia ions as well as the growth of presumptive coliforms were reduced (p < 0.05) in the three simulated colon vessels during the treatment. Finally, in vitro fermentation of Mexican "taco" showed a possible potential functional profile of an ancestral staple food due to the production of SCFA that may exert beneficial effects. Graphical abstract Unlabelled Image Highlights • Corn tortilla and common beans known as "taco" was evaluated in a SHIME® system. • The SCFAs production was higher during treatment period than basal period. • Molar ratio for acetic, propionic, and butyric was 55.04: 13.30: 31.65 respectively. • Ammonia ions were reduced 91% during treatment • Mexican "taco" showed a potential functional profile of an ancestral staple food. [ABSTRACT FROM AUTHOR]

This paper presents TACO (Toolchain for Automated Control and Optimization), which is a Modelica-based automated toolchain for model predictive control (MPC) of building systems. Its goal is to significantly reduce the engineering expertise and the time investment required for applying MPC to buildings. TACO is based on JModelica. Modifications compared to JModelica are discussed and the implementation of our custom MPC problem formulation is presented. The implementation is verified using two example models and is benchmarked with respect to accuracy and computation time. These results show that the computation time can be reduced significantly using the toolchain options, while only slightly reducing the controller optimality. [ABSTRACT FROM AUTHOR]

Objective/Background: Phagolysosome process in macrophage of leprosy patients' is important in the early phase of eliminating Mycobacterium leprae invasion. This study was to clarify the involvement of Rab5, Rab7, and trytophan aspartate-containing coat protein (TACO) from host macrophage and leprae lipoarabinomannan (Lep-LAM) and phenolic glycolipid-1 (PGL-1) from M. leprae cell wall as the reflection of phagolysosome process in relation to 16 subunit ribosomal RNA (16S rRNA) M. leprae as a marker of viability of M. leprae. Methods: Using a cross sectional design study, skin biopsies were obtained from 47 newly diagnosed, untreated leprosy at Dr Soetomo Hospital, Surabaya, Indonesia. RNA isolation and complementary DNA synthesis were performed. Samples were divided into two groups: 16S rRNA M. leprae-positive and 16S rRNA M. leprae-negative. The expressions of Rab5, Rab7, TACO, Lep-LAM, and PGL-1 were assessed with an immunohistochemistry technique. Result: Using Mann–Whitney U analysis, a significant difference in the expression profile of Rab5, Rab7, Lep-LAM, and PGL-1 was found (p < .05), but there was no significant difference of TACO between the two groups (p > .05). Spearman analysis revealed that there was a significant correlation between the score of Rab5, Rab7, Lep-LAM, and PGL-1 and the score of 16S rRNA M. leprae (p < .05). Conclusion: In M. leprae infection, Rab5, Rab7, and Lep-LAM play important roles in the failure of phagolysosome process via a membrane trafficking pathway, while PGL-1 plays a role via blocking lysosomal activities. These inventions might be used for the development of an early diagnostic device in the future.

Abstract Objectives Transfusion-related adverse events (TRAE) can contribute to patient morbidity and mortality. In this brief narrative review, the strategies that clinicians can apply at the bedside to avoid TRAE are discussed. Methods Strategies to avoid the following five types of TRAE were reviewed: transfusion-associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI), transfusion-associated hypothermia (TAH), transfusion-related allergic reactions (TRAR) and acute haemolytic transfusion reactions (AHTR). Results Minimizing exposure to blood components is fundamental to TRAE avoidance. Pre-transfusion assessment can identify patients at risk of TACO, TRAR and TAH, and avoidance steps implemented. Preventive strategies for TACO include lower transfusion rate, 'one unit at a time' transfusion policy and possibly diuretic medication. Patients with past history of TRAR should preferably be given plasma-free blood components; anti-histamine medication prior to transfusion could be considered. TAH is common in the massive transfusion setting, particularly trauma patients. Warming of patients are key strategies to avoid TAH. Identification of patients at risk of TRALI is more opaque; however, any measures that limit pulmonary inflammation prior to transfusion may decrease the risk of TRALI. Causes of AHTR are commonly due to human error and failure to apply rigorous cross-checks of patient and issued RBC component blood groups. Conclusions Beneficial strategies to avoid TRAE include judicious use of blood components, identification of high-risk patients, adherence to recommended clinical processes and awareness of TRAE pathophysiology. More evidence is warranted to better guide clinicians in the prevention of TRAE. [ABSTRACT FROM AUTHOR]

In the United States, roughly 4.5 million patients per year receive transfusions of various blood products. Despite the lifesaving benefits of transfusion therapy, it is an independent risk factor for infection, morbidity, and death in critically ill patients. It's important for nurses to understand the potential complications patients face when blood products are administered and to recognize that patients who have received blood products in the past remain at risk for delayed reactions, including immune compromise and infection. Here, the authors review the blood products that are commonly transfused; discuss potential complications of transfusion, as well as their associated signs and symptoms; and outline current recommendations for transfusion therapy that are widely supported in the medical and nursing literature. [ABSTRACT FROM AUTHOR]

Transfusion associated circulatory overload (TACO) is a diagnostic challenge in a critically ill postoperative patient with acute respiratory distress and chronic kidney disease (CKD). Transfusion associated acute lung injury (TRALI) and pulmonary embolism (PE) are other clinical possibilities to consider in this clinical scenario. As computed tomography (CT) pulmonary angiogram is relatively contraindicated in the presence of CKD to rule out PE, an ultrasound doppler study of lower extremities for deep-vein thrombosis, and an echocardiogram for evidence of right heart strain could be considered. Additionally, laboratory testing for elevated N-terminal pro--brain natriuretic peptide (NT-pro-BNP) levels may help narrow the diagnosis. [ABSTRACT FROM AUTHOR]

Objectives Transfusion-associated circulatory overload (TACO) is a severe pulmonary transfusion reaction and leading cause of transfusion-related morbidity and mortality in Europe. TACO is of particular importance in critically ill patients, since they often receive blood transfusions and have multiple risk factors for TACO. This study investigates transfusion practices in patients at risk of developing TACO, and furthermore knowledge concerning risk factors, diagnoses and treatment strategies among Dutch intensive care unit (ICU) fellows. Material and methods An unannounced paper-based survey was conducted among Dutch ICU fellows during an educational conference. The survey consisted of 16 multiple and open choice questions. Results Of all 65 Dutch ICU fellows 56.8% completed the survey; of respondents 88.9% identified the correct constellation of symptoms for TACO. In total, 29.7% of the respondents are aware they are obligated to report TACO cases to the blood bank. Major risk factors for TACO that respondents identified were reduced left ventricular function, infusion volume and infusion rate. In a non-emergency setting, 45.9% of fellows start red blood cell transfusion with 2 units or more. Transfusion rates exceeded national guidelines in 15.4% of fictitious cases. TACO is treated with furosemide by 94.5% of the fellows, however goals of the therapy varied greatly. Conclusion Dutch ICU fellows are knowledgeable of TACO symptoms, risk factors and treatment, however knowledge on reporting and transfusion practice in the setting of at risk patients for TACO should be improved. [ABSTRACT FROM AUTHOR]

Respiratory transfusion-related reactions are not very frequent, partly also because recognition and reporting transfusion reactions is still underemphasized. Tis article describes the most important respiratory transfusion reactions, their pathophysiology, clinical picture and treatment strategies. Respiratory transfusion related reactions can be primary or secondary. The most important primary transfusion-related reactions are TRALI - transfusion-related acute lung injury, TACO – transfusion-associated circulatory overload, and TAD - transfusion-associated dyspnea. TRALI is immuneassociated injury of alveolar basal membrane, which becomes highly permeable and causes noncardiogenic pulmonary edema. Treatment of TRALI is mainly supportive with oxygen, fluids (in case of hypotension) and in cases of severe acute respiratory failure also mechanic ventilation. TACO is caused by volume overload in predisposed individuals, such as patients with heart failure, the elderly, infants, patients with anemia and patients with positive fluid balance. Clinical picture is that of a typical pulmonary cardiogenic edema, and the therapy is classical: oxygen and diuretics, and in severe cases also non-invasive or invasive mechanical ventilation. TAD is usually a mild reaction of unknown cause and cannot be classified as TACO or TRALI, nor can it be ascribed to patient’s preexisting diseases. Although the transfusion-related reactions are not very common, knowledge about them can prevent serious consequences. On the one hand preventive measures should be sought, and on the other early recognition is beneficial, so that proper treatment can take place.

The spectrum of adverse reactions to blood product transfusion ranges from a benign clinical course to serious morbidity and mortality. There have been many advances in technologies and transfusion strategies to decrease the risk of adverse reactions. Our aim is to address a few of the advancements in increasing the safety of the blood supply, specifically pathogen reduction technologies, bacterial contamination risk reduction, and transfusion associated acute lung injury risk mitigation strategies.

Objective/Background Phagolysosome process in macrophage of leprosy patients’ is important in the early phase of eliminating Mycobacterium leprae invasion. This study was to clarify the involvement of Rab5, Rab7, and trytophan aspartate-containing coat protein (TACO) from host macrophage and leprae lipoarabinomannan (Lep-LAM) and phenolic glycolipid-1 (PGL-1) from M. leprae cell wall as the reflection of phagolysosome process in relation to 16 subunit ribosomal RNA (16S rRNA) M. leprae as a marker of viability of M. leprae . Methods Using a cross sectional design study, skin biopsies were obtained from 47 newly diagnosed, untreated leprosy at Dr Soetomo Hospital, Surabaya, Indonesia. RNA isolation and complementary DNA synthesis were performed. Samples were divided into two groups: 16S rRNA M. leprae -positive and 16S rRNA M. leprae -negative. The expressions of Rab5, Rab7, TACO, Lep-LAM, and PGL-1 were assessed with an immunohistochemistry technique. Result Using Mann–Whitney U analysis, a significant difference in the expression profile of Rab5, Rab7, Lep-LAM, and PGL-1 was found ( p < .05), but there was no significant difference of TACO between the two groups ( p > .05). Spearman analysis revealed that there was a significant correlation between the score of Rab5, Rab7, Lep-LAM, and PGL-1 and the score of 16S rRNA M. leprae ( p < .05). Conclusion In M. leprae infection, Rab5, Rab7, and Lep-LAM play important roles in the failure of phagolysosome process via a membrane trafficking pathway, while PGL-1 plays a role via blocking lysosomal activities. These inventions might be used for the development of an early diagnostic device in the future. [ABSTRACT FROM AUTHOR]

SUMMARY Objectives and background There are few studies of quality interventions to mitigate the risk of transfusion-associated circulatory overload ( TACO). Our aim was to reduce TACO risk in patients admitted to internal medicine at our hospital, by addressing gaps in transfusion practice. Materials and methods A 3-month baseline audit of red blood cell ( RBC) transfusion orders was conducted. An intervention consisting of a transfusion order set and physician checklist was developed and implemented based on identified gaps, followed by a 3-month post-intervention audit. Compliance with appropriateness criteria for RBC transfusion was ascertained, along with documentation of transfusion rate, diuretic usage and consent. Results A total of 97 transfusion orders from 68 inpatients and 95 orders from 62 inpatients were audited in the baseline and post-intervention groups, respectively. Compliance with appropriateness criteria was similar pre- and post-intervention (87 versus 85%, P = 0·81). Specification of transfusion rate improved (84 versus 98%, P < 0·01), and diuretics were appropriately ordered more frequently for patients with TACO risk factors (37 versus 64%, P < 0·01). Timing of diuretics shifted from between or post-transfusion to pre-transfusion (35 versus 86%, P < 0·01), without increases in hypokalemia or acute kidney injury. No case of TACO was observed during the study. Documentation of specific risks discussed during consent discussion improved (4 versus 23%, P < 0·01). Conclusion A checklist and order set are tools that can improve the quality of transfusion orders by increasing the judicious use of pre-transfusion diuretics and augmenting the specification of transfusion rate. These interventions could be adapted to electronic order formats to improve transfusion safety. [ABSTRACT FROM AUTHOR]

There have been few reports on pediatric transfusion-associated circulatory overload (TACO). A 5-year-old boy with neuroblastoma underwent resection of the residual tumor. Because anemia progressed at the end of the operation, transfusion of red cell component was initiated. Ten minutes later, he suddenly developed hypoxemia, tachypnea, and tachycardia. Although elevated blood pressure and bilateral infiltrative shadows on chest X-rays were not observed, TACO was diagnosed based on positive balance during operation and N-terminal pro-brain natriuretic peptide elevation. He had no cardiac or renal disorder; however, mild cardiac and/or renal damage due to a long history of chemotherapy and bias toward his primary hematological and malignant disease may have affected the development of TACO. [ABSTRACT FROM AUTHOR]

The article discusses topics and recommendations from the Annual Serious Hazards of Transfusion (SHOT) Report 2013. Topics include human factors in medical practice, the steps in blood transfusion process, and transfusion-associated circulatory overload (TACO) reports. Some key recommendations include the inclusion of all ABO-incompatible red cell transfusions to never events and the consideration of blood component transfusion management as a specific standard by the Care Quality Commission.

Résumé: Les complications respiratoires de la transfusion sanguine ont plusieurs étiologies possibles. Le diagnostic de Transfusion-Associated Circulatory Overload (TACO) est souvent le premier évoqué, celui de Transfusion-Related Acute Lung Injury (TRALI), mieux défini depuis la conférence de Toronto de 2004, l’est plus rarement. Son incidence selon les données épidémiologiques françaises est faible. Des réactions fébriles non hémolytiques, des allergies, des infections et des embolies pulmonaires sont également rapportées. L’objectif de notre travail a été de déterminer l’importance épidémiologique des différentes complications de type respiratoire d’une transfusion sanguine. Ce travail a été mené de façon rétrospective sur les accidents transfusionnels survenus dans 6 centres de santé de la région Champagne-Ardenne, déclarés à l’hémovigilance entre 2000 et 2009 et comportant une symptomatologie respiratoire. L’analyse des dossiers a été réalisée par un collège d’experts. Sur les 83 dossiers de complications respiratoires retrouvés (316864 produits sanguins administrés), 26 étaient des TACO, 12 des TRALI (seulement 6 cas étaient identifiés par l’enquête initiale d’hémovigilance), 18 des réactions fébriles non hémolytiques, 16 des cas d’allergie, 5 des infections bactériennes transmises par la transfusion et 2 des embolies pulmonaires. Les 6 nouveaux TRALI diagnostiqués étaient préalablement étiquetés TACO pour 2 d’entre eux, allergie et infection pour 2 autres cas et le diagnostic considéré comme inconnu pour les 2 derniers. Notre étude a retrouvé une incidence des cas de TRALI 2 fois plus importante que celle déclarée auparavant. L’interprétation des données par un comité multidisciplinaire modifie 20 % des diagnostics. Cette étude montre des imperfections de notre système de notification des accidents de la transfusion sanguine quand un observateur médical unique analyse les dossiers. [ABSTRACT FROM AUTHOR]

SUMMARY Translation of Annotated COde (TACO) is a SAT-based tool for bounded verification of Java programs. One challenge many formal tools share is to provide a practical interface for a non-proficient user. In this article, we present an Eclipse plug-in for the static verifier TACO. This plug-in allows a user to walk a counterexample trace mimicking a debugging session. TacoPlug (our plug-in) uses and extends TACO to provide a better debugging experience. TacoPlug interface allows the user to verify an annotated software using the TACO verifier. If TACO finds a violation to the specification, TacoPlug presents it in terms of the annotated source code. TacoPlug features several views of the error trace to facilitate fault understanding. It resembles any software debugger, but the debugging occurs statically without executing the program. Furthermore, should a dynamic analysis be required, TacoPlug presents the user with a unit test case generated by TACO based on the detected violation. We show the usability of our tool by means of a motivational example taken from a real-life software error. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

SUMMARY Objectives To construct an alternative policy for the donor selection of platelet concentrate ( PC), a clinical study exploring the features of lung injury following PC administration is needed. Background Although a male-donor-only policy for plasma products appears to have efficiently reduced transfusion-related acute lung injury ( TRALI), this policy may not be applied to PC because of supply shortages. Methods and Materials We prospectively examined pulmonary function after the transfusion of PC in informed surgical patients treated at a tertiary university hospital in Japan. The contributions of immunoreactive substances contained in the PC to respiratory function after PC transfusion was then statistically examined. Results Eighty-six patients (56 men, 30 women) were enrolled in the analysis. Fifty-four cases experienced respiratory failure ( PaO2/ FiO2 <300 mmHg) after transfusion. Five cases were diagnosed as possible TRALI based on permeability pulmonary oedema, while 23 cases were diagnosed as transfusion-associated circulatory overload ( TACO) based on chest radiograph findings. A multivariate logistic regression analysis identified the presence of anti-granulocyte antibody as a significant predictor of possible TRALI [ P = 0·023; odds ratio ( OR), 13·0; 95% confidence interval ( CI), 1·4-118·3]. Meanwhile, anti-leukocyte antibody class II was identified as a significant independent predictor of TACO ( P = 0·010; OR, 18·4; 95% CI, 2·0-170·1). Conclusions Our data suggest that antibodies contained in PC may contribute to the deterioration of respiratory function after PC transfusion, although the diagnoses of TACO and TRALI may have overlapped among the patients with pulmonary distress in this cohort. [ABSTRACT FROM AUTHOR]

Abstract: “Transfusion-related acute lung injury” (TRALI) is a post-transfusion lesional pulmonary edema, potentially severe, better defined since the conference of Toronto in 2004. The incidence of TRALI reported in France remains low in part because of its ignorance by physicians. The objective of our study was to evaluate retrospectively transfusion accidents with respiratory complications that occurred in Nancy University Hospital and reported to the haemovigilance between 1996 and 2006, from the software “Traceline” listing all the blood transfusion complications from signs observed. The analysis of the files has been performed by applying rigorously diagnostic criteria of Toronto. Forty-one cases of respiratory complications were found in 34,573 blood products. Ten cases of TRALI were diagnosed while only one case had been reported to the haemovigilance. The remaining nine cases were previously labeled transfusion-associated circulatory overload (TACO). No cases of TRALI have been identified in the ICU. Our work can find an incidence of TRALI 10 times greater than previously reported. Ignorance of TRALI and the lack of consensus definition before 2004 are not sufficient to explain these results. This study demonstrates the potential interest of database and computerized declaration system based on the symptoms observed. It highlights the vulnerability of the current haemovigilance too dependent on a single medical observer. Although TRALI are recognized as serious complications, sometimes requiring resuscitative care, our work was not isolated severe TRALI in ICU. Physician awareness of TRALI to the identification and to the declaration, including ICU should be continued. Finally, the diagnostic criteria for TRALI must be adapted to the ICU. [Copyright &y& Elsevier]

Transfusion-related acute lung injury (TRALI) is a frequently under-diagnosed, although potentially fatal, condition that represents a leading cause of transfusion-related morbidity and mortality even in pediatric patients. Its main clinical features are characterized by rapidly evolving respiratory distress, hypoxia, pulmonary edema, and bilateral infiltrates on chest radiograph during or within 6 h of transfusion. We present a case of severe TRALI associated with myocardial stunning that occurred in a 14-year-old girl, and review the existing literature of pediatric TRALI. Our report suggests a potential role for NIV in the management of TRALI as the best profile both in terms of safety and effectiveness for hematologic patients. [ABSTRACT FROM AUTHOR]

The risks of transfusion remain significant. Familiarity with the incidence, etiology, management, and prevention of commonly encountered transfusion reactions is integral to the practice of transfusion medicine. This review intends to serve as a practical guide reflecting the current understanding of adverse transfusion events, clinical features helpful for diagnosis, and recommended management strategies for typical scenarios. Severe and mild transfusion reactions are covered, with a focus on the distinguishing features of challenging clinical dilemmas. Topics include pulmonary complications of transfusion, hemolytic reactions, allergic and anaphylactic reactions, septic reactions, and febrile responses to transfusion. We also discuss a consultative approach to evaluation and reporting of transfusion reactions. Educational Objectives Readers should be able to describe the incidence, pathogenesis, management, prevention, and reporting of transfusion reactions. [ABSTRACT FROM AUTHOR]

Cardiopulmonary adverse events after transfusion include transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), which are potentially lethal and incompletely understood. To determine whether the incidence of TRALI and TACO was affected by leukoreduction we conducted a retrospective, before-and-after study of acute transfusion reactions for the 7 years before and after introduction of universal leukoreduction in 2000, involving 778,559 blood components. Substantial decreases occurred in the rates of TRALI (−83%; from 2.8 cases per 100,000 components before to 0.48 after universal leukoreduction; p = 0.01), TACO (−49%; 7.4 to 3.8 cases per 100,000; p = 0.03), and febrile reactions (−35%; 11.4 to 7.4 cases per 10,000; p < 0.0001). The incidence of allergic reactions remained unchanged (7.0 per 100,000 before and after universal leukoreduction). These outcomes were primarily attributable to decreased TRALI and/or TACO associated with red blood cell (RBC) and platelet (PLT) transfusions (−64%) with notably smaller decreases associated with fresh-frozen plasma or cryoprecipitate transfusions (−29%). The incidence of TRALI and/or TACO after 28,120 washed RBC and 69,325 washed transfusions was zero. These data suggest novel hypotheses for further testing in animal models, in prospective clinical trials, and via the new US hemovigilance system: 1) Is TACO or TRALI mitigated by leukoreduction? 2) Is the mechanism of TACO more complex than excessive blood volume? and 3) Does washing mitigate TRALI and TACO due to PLT and RBC transfusions? [ABSTRACT FROM AUTHOR]

Abstract: Pulmonary oedema after transfusion of blood products may be hydrostatic (transfusion-associated circulatory overload [taco]) or exsudative (transfusion-related acute lung injury [trali]). Both conditions have been recognized as major hazards to transfusion recipients. Risk characterization is necessary to improve safety and to monitor trends in the national blood transfusion system. A collaborative multidisciplinary working group of the French National Hemovigilance Committee has proposed an analysis framework for case definitions and classification. The method relies on internationally used definitions and is adapted to the codification procedures used in the french transfusion incident reports electronic data management. [ABSTRACT FROM AUTHOR]

Abstract: Pulmonary oedemas occurring during or after a blood transfusion appear as the most frequent serious immediate incidents in the French hemovigilance database. They include transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI). TACO are a major cause of transfusion-related death in France. TRALI are more and more recognized and notified. In no case, pooled fresh frozen plasma (100 donations) treated with solvent–detergent were involved in French TRALI cases. A logigrame will allow hemovigilance officers to better classify pulmonary oedemas in e-fit, the French hemovigilance database. [Copyright &y& Elsevier]

Summary: Transfusion related lung injury is almost certainly related to the administration of blood products containing antibodies in the plasma. Those antibodies may have developed during pregnancy or following blood transfusion. They react with specific ‘cognate’ antigens in the recipient and in some patients, but not all, this results in an acute lung injury pattern. The problem resides in the plasma, so the incidence with FFP is far higher than with red cells. Blood transfusion services have adopted several ways of reducing risk such as using untransfused male donors. Leucodepletion may also have a benefit. Diagnosis is an issue as it is easily confused with transfusion associated circulatory overload TACO and often the right preconditions exist for both. Although most sources agree that the condition usually occurs within 6h of transfusion some new information from critically ill patients has suggested that a condition called ‘delayed TRALI’ may exist, but this is currently contentious. The natural history of the condition is extremely variable and there is an associated mortality, 5–10%. Most patients do require ventilation but most do well. [Copyright &y& Elsevier]