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References

  1. Dzieczkowski JS, Anderson KC. Transfusion biology and therapy. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:662-667.
  2. Skeate RC, Eastlund T. Distinguishing between transfusion related acute lung injury and transfusion associated circulatory overload. Curr Opin Hematol. 2007;14(6):682-687.
  3. United States Renal Data System. 2004 Annual Data Report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2004.
  4. New York State Department Council on Human Blood and Transfusion Services. Guidelines for transfusion of red blood cells—adults, 3rd edition. http://www.wadsworth.org/labcert/blood_tissue/ rbcsadults0812final.pdf. Published 2012. Accessed August 8, 2014.
  5. National Kidney Foundation. KDOQI™ clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis. 2006;47(5)(suppl 3):S1-S145.
  6. EPOGEN® (epoetin alfa) prescribing information, Amgen.
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Transfusions have benefits and risks1-4

  • According to the National Kidney Foundation KDOQI™, despite use of pharmacologic agents for the treatment of anemia, blood transfusions are occasionally required, particularly in the setting of acute bleeding.5
  • RBC transfusions should be used judiciously in patients with CKD, especially because of the potential development of sensitivity affecting future kidney transplant.5

Benefits and risks associated with transfusions

Potential Benefits

  • Prompt increase in RBCs
  • Improved oxygen delivery to tissues
  • Avoidance of myocardial ischemia
  • Relief of acute symptoms

Potential Risks

  • Allergic reactions
  • Febrile reactions
  • Hemolytic reactions
  • Immune-related reactions, including:
    • Increased panel-reactive antibodies (PRA)
    • Transfusion-related acute lung injury (TRALI)
  • Nonimmunologic reactions (eg, fluid overload, transfusion associated circulatory/cardiovascular adverse events)
  • Infections

IMPORTANT SAFETY INFORMATION

  • Patients with CKD and an insufficient hemoglobin response to ESA therapy may be at even greater risk for cardiovascular reactions and mortality than other patients. A rate of hemoglobin rise of > 1 g/dL over 2 weeks may contribute to these risks.
  • In controlled clinical trials, ESAs increased the risk of death in patients undergoing coronary artery bypass graft surgery (CABG) and the risk of deep venous thrombosis (DVT) in patients undergoing orthopedic procedures.


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Reducing the risk of alloimmunization and/or other RBC transfusion-related risks may be a goal for patients with CKD.5,6