Anemia is known as a risk factor for hospitalization and death in congestive heart failure. In addition, patients with diuretic resistance are often associated with anemia, which could be corrected with a combination of subcutaneous erythropoietin and intravenous iron, sometimes transfusion. Herein, we present a case of congestive heart failure with diuretic resistance and anemia corrected by transfusion. The patient was a 72 years old woman with left ventricular non-compaction and LVEF 65%. The aortic valve replacement was performed 21 years ago. She began to repeat heart failure hospitalizations from 6 years ago. At this time, she complained dyspnea, weight gain, leg edema, and the blood test revealed BNP 1136 pg/dL. She was hospitalized for the treatment of acute decompensated heart failure. Initially, intravenous loop diuretic and hANP were administered but decongestion was not satisfactory. On day 7, Tolvaptan was also initiated. However, the diuretic resistance was not resolved with the remained pleural effusions. On day 13, correction of anemia (Hb from 6.7 to 11.8 g/dL) by blood transfusion improved diuretic resistance and finally successful decongestion was achieved.
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