TRANSFUSION-ASSOCIATED CIRCULATORY OVERLOAD COMPLICATED BY SEPTICEMIC SHOCK FOLLOWING SEPTIC ABORTION: A RARE CASE REPORT.

Abstract

Transfusion-associated circulatory overload (TACO) is a serious transfusion reaction characterized by acute respiratory compromise and pulmonary edema developing within hours of blood component administration. Although commonly associated with cardiac or renal comorbidities, TACO may also occur in previously healthy individuals exposed to rapid or high-volume transfusions, particularly in the context of systemic inflammation. We describe a rare case of TACO complicated by septicemic shock following an unsupervised medical abortion. A 30-year-old woman presented with septic abortion and severe anemia after self-administering abortifacients. She underwent emergency uterine evacuation and received multiple blood products for hemorrhage control. Shortly thereafter, she developed acute dyspnea, hypertension, elevated central venous pressure, and hypoxia. Radiographic evaluation demonstrated bilateral pulmonary edema, and serum BNP was markedly elevated. Simultaneously, features of septic shock with hypotension, elevated lactate, and leukocytosis were noted. She was managed with cautious fluid restriction, intravenous diuretics, vasopressor support, non-invasive ventilation, and broad-spectrum antibiotics. Gradual clinical improvement was observed with resolution of pulmonary edema and stabilization of hemodynamics. She was discharged in stable condition and received contraceptive counselling. This case underscores the diagnostic challenges in differentiating TACO from transfusion-related acute lung injury (TRALI) and acute respiratory distress syndrome (ARDS), particularly in the presence of sepsis where clinical features overlap. Prompt recognition of TACO features—post-transfusion pulmonary edema, volume overload signs, and elevated BNP—enables targeted management. The report also highlights the risks of unsupervised medical abortion, emphasizing the importance of safe abortion practices, early medical evaluation, and post-procedural counselling. Multidisciplinary management and individualized transfusion strategies are crucial to optimizing outcomes in such complex presentations.