A patient with cirrhosis may be refractory to red blood cell transfusion for a number of reasons.
Patient selection: cirrhosis
Presentation: failure to see the expected increase in hemoglobin following red blood cell transfusion (about 1 g/dL per unit)
Differential diagnosis:
(1) bleeding
(2) hemolytic transfusion reaction
(3) Zieve's syndrome
(4) hemolytic anemia due to other cause (AIHD, infection)
(5) hypersplenism
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Specialty: Clinical Laboratory, Gastroenterology
