American Board of Internal Medicine (ABIM) Certification Practice Exam

What immediate management is suggested for a patient experiencing transfusion-associated circulatory overload?

1. Increase transfusion speed

2. Administer diuretics

3. Monitor vital signs closely

4. Switch to another blood type

The correct answer is: Administer diuretics

Transfusion-associated circulatory overload (TACO) is characterized by the rapid accumulation of fluid in the lungs and other tissues, leading to symptoms such as shortness of breath, increased blood pressure, and pulmonary edema. In cases of TACO, the management focuses on alleviating the cardiovascular strain caused by excess fluid volume. Administering diuretics is the immediate management strategy that directly addresses the underlying problem of fluid overload. Diuretics help to promote the excretion of excess fluid through the kidneys, thus reducing the overall volume in circulation and alleviating pulmonary congestion. This can lead to a decrease in blood pressure and improved respiratory function, which are critical in the setting of TACO. Other options, such as increasing the transfusion speed, would exacerbate the circulatory overload by further increasing fluid volume rapidly. Monitoring vital signs closely is essential, but it does not provide a direct intervention to relieve the condition. Switching to another blood type does not address the problem of fluid overload and is therefore not a relevant solution in this immediate scenario. In summary, administering diuretics is the most effective immediate response to manage transfusion-associated circulatory overload, as it targets the excess fluid causing the symptoms.