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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