Implementation of a Mandatory Weight Box on the Trust Electronic

Ordering Cross-Match Form to Reduce the Risk of

Transfusion Associated Circulatory Overload (TACO)

Rachel Suri, Angela Short, Fernando Fegarido, Sue Rudd, Dr Sandy Kidd, Dr Roslin Zuha

Background
The numbers of TACO incidents reported are increasing and this is of
national and local concern.
The HTT felt it essential to implement the screening of red cell
requests for low body weight patients to aid in the identification of
patients who may be at risk of TACO.
The standard method of requesting blood in the Trust is via electronic
ordering and electronic issue of blood is used where appropriate.

Methods
For the project, the two key contributing factors to
TACO were identified as patient weight and volume
transfused. A mandatory weight field was added to
the electronic request form.
In addition, on the electronic form it was advised that
the paediatric formula for calculating volume for
transfusions should be used in adults weighing 50kg
or less (see below).
The weight automatically appears on the request
form received in the laboratory. All requests for more
than 2 units in a patient not bleeding with a body
weight less than 50kg were referred to a
haematologist. The procedure was implemented
throughout the Trust on 05/11/2013
Results
There have been no incidents of TACO reported in
the Trust since the implementation of this initiative.
At St Helier 1575 cross-match requests were made
between November 2013 and March 2014. See table
below.
Audit results between November 2013
and March 2014
Number of cross-match requests 1575
Number of requests for adult patients 133 (8.4%)
weighing 50 kg or less

Cases where request reduced after 21 (15.7%)

referral.

Total reduction in number of units issued 29

Conclusions
At present, it is not possible to conclude that this
procedure is responsible for the absence of TACOs.
There is evidence of reduced numbers of units being
issued.
The initiative has highlighted the importance of
patient pre-assessment within Patient Blood
Management. We are not aware of any other on-line
cross-match request forms which factor in adult
body weight in the UK. The true positive impact of
this initiative will undoubtedly become clearer with
time.

Paediatric formula
Volume of red cells in mls = (desired Hb g/l – actual Hb g/l) x weight in kg x 3/10.