A CKD patient had to undergo dialysis. His Hb was 5.2 gm% so two blood transfusions were to be given. First bag was completed in 2 hours. Second was started and midway he developed shortness of breath, hypertension. Vitals: BP 180/120 mm Hg and pulse rate 110/min. What is the cause?

Ans. B Transfusion related circulatory overloadRef: Harrison 20th ed. pg. 814* This CKD patient has developed severe anemia which is a compensated heart failure state. The patient was given first unit of blood in two hours instead of standard four hours and he is already in compensated heart failure.* The acute decompensation due to volume overloading that has subsequently occurred will result in pulmonary edema and shortness of breath. This presentation is called as transfusion associated circulatory overload.* Ideally patients of CKD should be given erythropoietin injections to reduce the incidence of having severe anemia.