Complications

Complication
Timeframe
Likelihood
long term
high

With the repeated transfusions required for chronic hemolytic anemias, development of significant antibody burden against packed red blood cells may make cross-matching very difficult.

Restricting transfusions to symptomatic anemia is important.

Transfusion reaction

long term
medium

Unlikely with acquired hemolytic process, but common with hereditary hemolytic anemias.

Cholelithiasis

long term
medium

With the repeated transfusions required for chronic hemolytic anemias, patients who are on a regular transfusion program (transfusions every three months or less) should be monitored for iron overload and complications of iron overload. Recommendations for evaluation of iron overload in chronically transfused patients include serum ferritin, hepatic iron assessment by quantitative magnetic resonance imaging, or liver biopsy annually and a yearly echocardiogram.[72]

Treatment of iron overload can be with desferrioxamine, deferiprone, or deferasirox.[72]

long term
medium

A significant percentage of patients with hemolysis will develop venous thromboembolism.[73][74][75]

Anticoagulant prophylaxis should be considered for all patients, but particularly for those with additional risk factors such as prior thrombosis or pregnancy.

Deep vein thrombosis

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