Complications
Increased cardiac output necessitated by anaemia often worsens cardiac failure; it may induce new congestive heart failure in patients with previous borderline compensation.
Increased cardiac work due to anaemia may trigger angina with less exertion in patients with known CAD or may induce new angina in patients with significant but previously occult CAD.
Fever, chills, pruritus, hives, hypertension, anaphylaxis, death.
Drop in haemoglobin 3 to 10 days after transfusion due to haemolysis of some or all of transfused red blood cell units.
Results from development of allo-antibody specific for donor cell antigen(s).
Normally self-limited.
Usually occurs due to ABO mismatch.
Occurs rarely as a result of an irregular antibody that is haemolytic.
May cause acute renal failure or death.
Acute non-cardiac pulmonary oedema, usually due to antibodies in donor plasma specific for recipient granulocyte antigen.
Often requires intensive care. Occasionally fatal.
The increase in haemoglobin (Hb) with ESA therapy may raise blood pressure.
This has been mainly observed in patients with renal failure with pre-existing hypertension.
Particularly occurs when Hb rises too rapidly or overshoots target Hb of 110 to 120 g/L (11-12 g/dL).
Treatment with antihypertensives may be necessary.
Chronic transfusion therapy leads to iron deposition in, and toxicity to, liver, heart, and endocrine organs.
Patients who receive long-term transfusions may benefit from iron chelation therapy.
Occurs with repeated exposure to donor lymphocytes present in packed red blood cells.
These cells stimulate the immune system to produce anti-HLA antibodies.
This is greatly reduced by leukofiltration, either on the day of collection or at the time of transfusion.
Risk of red blood cell transfusion-transmitted infectious disease in blood supply may vary with country and for infectious agent. Risk in the US is: HIV-1 is 1 in 2,000,000; HTLV-I/II is 1 in 3,000,000; hepatitis A is unknown, likely <1 in 1000,000; hepatitis B is 1 in 205,000; hepatitis C is 1 in 2,000,000; agent of Creutzfeldt-Jacob disease is unknown, likely <1 in 1,000,000; bacteria associated with systemic sepsis is 1 in 500,000.[102]
ESAs may stimulate tumour growth in some types of cancers.
Recent data have shown increased mortality in certain populations treated with ESAs.[88]
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