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cardio.acute-hf.infusion-reaction-cardiotoxicity.v1PRODUCTION
cardio.acute-hf.infusion-reaction-cardiotoxicity.v1

Acute HF — Infusion-reaction cardiotoxicity (mAb / CAR-T CRS / transfusion reaction / contrast)

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Peri-infusion cardiotoxicity = symptom onset within minutes-hours of biologic / CAR-T / blood / contrast infusion. Four phenotypes: mAb infusion reaction, CAR-T CRS, transfusion reaction (TRALI / TACO / hemolytic / anaphylactic), contrast reaction. CRITICAL FIRST STEP: STOP THE INFUSION immediately + maintain IV access. Cause-specific antidote: tocilizumab for CRS; epinephrine for anaphylaxis; diuretic for TACO; ventilatory support for TRALI; supportive for mAb infusion reaction.

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peri-infusion timing + agent + symptom complex framed

Patient inputs (19)

Older patients higher TACO + cardiotoxicity risk; informs CAR-T eligibility + transfusion volume + premedication tolerance

Cancer (CAR-T, mAb), autoimmune (infliximab, rituximab), hematologic (transfusion), procedural (contrast) — informs cause-specific antidote pathway

Specific agent (rituximab, infliximab, alemtuzumab, obinutuzumab, paclitaxel, IV iron, gadolinium, iodinated contrast, blood product) + premedication given (acetaminophen, antihistamine, corticosteroid) + cycle / dose number (first dose dominant for mAb CRS)

Symptom onset within minutes-hours of infusion start = peri-infusion reaction; this dossier; later onset (days-weeks) routes to specific late-onset cardiotoxicity engines (e.g., chemotherapy-induced.v1, checkpoint-inhibitor.v1)

Symptom complex differentiates: cytokine release (fever + hypotension + hypoxia + tachycardia) vs anaphylaxis (urticaria + bronchospasm + hypotension) vs TACO (dyspnea + JVD + crackles + HTN initially) vs TRALI (dyspnea + hypoxia + bilateral infiltrates without JVD/HTN)

Prior reaction history → premedication intensity + alternative agent consideration; documented allergy → epinephrine pre-positioned

Chronic HF / renal failure → TACO + iodinated contrast volume effects significantly higher risk; transfusion volume + rate adjustment + diuretic prophylaxis

eGFR for ACEi/ARB/ARNI dosing + IV-contrast nephropathy assessment

Troponin elevation indicates myocardial injury (CRS-CMP, mAb cardiotoxicity, anaphylaxis-induced ischemia, takotsubo); serial trending guides recovery + GDMT decision

NT-proBNP elevation suggests cardiac strain; baseline + serial for response tracking; helps differentiate TACO (high) from TRALI (variable)

Tissue hypoperfusion marker; SCAI staging for cardiogenic shock

ECG: tachyarrhythmia common in CRS, anaphylaxis; ischemic changes if anaphylaxis-induced ischemia or takotsubo; QTc baseline before any antiarrhythmic

Echo for LVEF + GLS strain + RV function + valvular; CRS-CMP often takotsubo-pattern (apical ballooning) and reversible

CXR: bilateral infiltrates without volume overload pattern (TRALI vs ARDS); cephalization + Kerley B + cardiomegaly + bilateral effusions (TACO); useful within 6h of transfusion

SBP guides shock recognition + epinephrine vs vasopressor decision + MCS consideration

Hypoxemia severity differentiates respiratory failure subtype + escalation to NIV / intubation

Peak 1-3h after anaphylaxis onset; confirms mast-cell-mediated mechanism vs CRS or other; window of opportunity for capture is narrow

IL-6 elevation in CRS (CAR-T or mAb) supports tocilizumab pathway; not always available emergently

Hemolytic transfusion reaction differential — LDH↑, haptoglobin↓, smear schistocytes; hyperK consequence

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Severity triggers (4)

4 need judgement
  • informationallife_threateningcar_t_crs_grade_3_or_4_with_cardiotoxicity_needing_tocilizumab_escalation
    CAR-T patient with CRS grade 3-4 (high-grade fever + hypotension requiring vasopressor + hypoxia requiring O2 ≥40%) + new cardiac decompensation (troponin elevation, LVEF drop, takotsubo pattern) — STAT tocilizumab + steroid + ICU + advanced HF consult
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningtrali_with_pao2_fio2_below_200_requiring_intubation
    Patient within 6h of blood transfusion with hypoxemic respiratory failure + bilateral infiltrates + no JVD/HTN (TRALI pattern) + PaO2/FiO2 <200 — intubation + lung-protective vent + AABB notification
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateninganaphylactic_shock_with_cardiac_arrest_or_refractory_hypotension
    Anaphylaxis with cardiac arrest OR refractory hypotension despite IM epinephrine × 3 + crystalloid bolus 1-2 L — IV epinephrine infusion + ICU + ECMO consideration
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevererecurrent_infusion_reactions_despite_premedication
    Patient with recurrent reactions at re-infusion despite full premedication protocol (acetaminophen + diphenhydramine + corticosteroid 30-60 min prior) — alternative agent + slow infusion rate + pre-emptive tocilizumab if CRS pattern
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Infusion-reaction cardiotoxicity — STOP infusion + cause-specific antidote (tocilizumab CRS; epinephrine anaphylaxis; diuretic TACO; respiratory support TRALI) + supportive ADHF bundle (ASH 2024 + Lee CRS PMID 24876563 + WAO 2020 anaphylaxis + AHA cardio-onc 2022 PMID 35403432)
axis: infusion_reaction_cardiotoxicity_phenotype
Selected axis "Infusion-reaction cardiotoxicity — STOP infusion + cause-specific antidote (tocilizumab CRS; epinephrine anaphylaxis; diuretic TACO; respiratory support TRALI) + supportive ADHF bundle (ASH 2024 + Lee CRS PMID 24876563 + WAO 2020 anaphylaxis + AHA cardio-onc 2022 PMID 35403432)" by default fallback (first axis)
  • tocilizumab
    first line
    anti_il_6_receptor_monoclonal_antibody
    8 mg/kg IV (max 800 mg) repeat q8h up to 4 doses • IV • q8h up to 4 doses
    triggers: car_t_crs_grade_2_or_higher_with_cardiotoxicity, cytokine_release_syndrome_with_hemodynamic_compromise
    Lee CRS PMID 24876563 + Ganatra JACC CardioOnc 2020 + ASCO/SITC CRS guidelines — anti-IL-6R first-line for CAR-T CRS grade ≥2 with end-organ involvement; reduces cardiotoxicity progression
    rxcui 612865
  • methylprednisolone
    first line
    systemic_corticosteroid
    125 mg IV (anaphylaxis or refractory CRS) or 1 mg/kg IV daily for CRS escalation • IV • as needed for anaphylaxis; q6-24h for CRS
    triggers: anaphylaxis_with_cardiovascular_compromise, crs_grade_3_or_4_after_tocilizumab, mab_infusion_reaction_severe
    WAO 2020 anaphylaxis + ASCO/SITC CRS — corticosteroid adjunct for anaphylaxis (after epinephrine) and refractory CRS (after tocilizumab); dexamethasone alternative 10-20 mg IV q6h
    rxcui 6902
  • epinephrine
    first line
    alpha_beta_adrenergic_agonist
    0.3 mg IM (1:1000) repeat q5-15 min; or 0.05-0.5 µg/kg/min IV infusion if persistent shock • IM/IV • q5-15 min IM; continuous IV if shock
    triggers: anaphylaxis_with_cardiovascular_or_respiratory_compromise, infusion_reaction_with_anaphylactoid_pattern
    WAO 2020 anaphylaxis Class I — epinephrine FIRST-LINE for anaphylaxis with cardiovascular / respiratory compromise; IM thigh preferred over SC; IV infusion if refractory hypotension
    rxcui 3992
  • diphenhydramine
    add on
    h1_antihistamine_first_generation
    25-50 mg IV • IV • q4-6h up to 24h
    triggers: anaphylaxis_or_mab_infusion_reaction
    WAO 2020 — H1 blockade adjunct after epinephrine; reduces urticaria + pruritus + bronchospasm contribution
    rxcui 3498
  • famotidine
    add on
    h2_antihistamine
    20 mg IV • IV • q12h
    triggers: anaphylaxis_with_cardiovascular_compromise, h1_alone_insufficient
    WAO 2020 — H2 blockade in combination with H1 superior to H1 alone for hypotension reversal
    rxcui 4278
  • furosemide
    first line
    loop_diuretic
    40-80 mg IV bolus then 5-10 mg/h infusion if needed • IV • as needed
    triggers: transfusion_associated_circulatory_overload_taco_with_pulmonary_edema
    DOSE PMID 21366472 — standard ADHF diuresis; first-line for TACO; NOT helpful for TRALI (TRALI is non-cardiogenic permeability edema)
    rxcui 4603
  • norepinephrine
    first line
    vasopressor_alpha1_beta1
    0.05-0.5 µg/kg/min titrate to MAP ≥65 • IV • continuous
    triggers: cardiogenic_or_distributive_shock_from_infusion_reaction, persistent_hypotension_after_epinephrine_for_anaphylaxis
    SOAP-II PMID 20200382 — first vasopressor for refractory cardiogenic + distributive shock; useful adjunct after epinephrine for anaphylaxis with persistent hypotension
    rxcui 7512
  • lactated Ringer crystalloid
    first line
    isotonic_crystalloid
    1-2 L IV bolus over 20-30 min • IV • as needed; cautious in cardiogenic component
    triggers: anaphylaxis_with_hypotension, distributive_shock
    WAO 2020 anaphylaxis — IV crystalloid bolus for anaphylactic hypotension; cautious in concurrent cardiogenic component (TACO, CRS-CMP) — start with 250-500 mL bolus and reassess
  • acetaminophen
    first line
    analgesic_antipyretic
    650 mg PO 30-60 min before infusion • PO • pre-infusion
    triggers: premedication_for_at_risk_infusion_protocol
    Standard premedication for at-risk infusions (rituximab, paclitaxel, IV iron, gadolinium); reduces febrile reaction component
    rxcui 161
  • hydrocortisone
    first line
    systemic_corticosteroid
    100 mg IV 30-60 min before infusion • IV • pre-infusion
    triggers: premedication_for_at_risk_infusion_protocol
    Standard premedication for at-risk infusions; reduces severity of subsequent reaction
    rxcui 5492
  • carvedilol
    first line
    beta_alpha_blocker
    3.125 mg PO BID titrate • PO • BID
    triggers: post_crs_cmp_recovered_lvef_below_40_stable
    GDMT once stable; CAPRICORN PMID 11356436 + ESC cardio-onc 2022 PMID 36017575
    rxcui 20352
  • sacubitril-valsartan
    first line
    arni
    24/26 mg PO BID titrate • PO • BID
    triggers: post_crs_cmp_recovered_lvef_below_40_acei_intolerant_or_de_novo_hf
    PIONEER-HF PMID 30403955 + ESC cardio-onc 2022 Class IIa
    rxcui 1656328
  • spironolactone
    first line
    mra
    12.5-25 mg PO daily • PO • daily
    triggers: post_crs_cmp_recovered_lvef_below_40_k_below_5_egfr_above_30
    RALES PMID 10471456 + ESC cardio-onc 2022 Class I
    rxcui 9997
  • empagliflozin
    first line
    sglt2_inhibitor
    10 mg PO daily • PO • daily
    triggers: post_crs_cmp_recovered_lvef_below_40_egfr_above_20
    EMPULSE PMID 35347356 + ESC cardio-onc 2022 Class IIa
    rxcui 1545653

outpatient playbook — drug actions (2)

  1. 1. continue 4-pillar GDMT until LVEF normalized + stable ≥6-12 mo (avoid TRED-HF withdrawal harm)
    rxcui 1656328
    ARNI + BB + MRA + SGLT2i at max tolerated • PO • as scheduled
    trigger: Persistent HFrEF
    TRED-HF PMID 30429051; ESC cardio-onc 2022
  2. 2. maintain epinephrine auto-injector if anaphylaxis confirmed
    rxcui 3992
    epinephrine 0.3 mg IM auto-injector refill • IM • as needed
    trigger: Confirmed anaphylactic risk
    WAO 2020

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: New cardiac decompensation (dyspnea, chest pain, hypotension, hypoxia) during or within hours of monoclonal antibody (rituximab, infliximab, alemtuzumab, obinutuzumab) infusion — peri-infusion cardiotoxicity / CRS reaction; CAR-T patient (within 14 d of infusion) with new cardiac decompensation + fever / hypoxia / hypotension — CRS-mediated cardiotoxicity (Cosenza JACC CardioOnc 2023; Alvi JACC 2019); Patient with new dyspnea / hypoxia / hypotension within 6h of blood transfusion — TRALI vs TACO vs hemolytic vs anaphylactic reaction.

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Acute HF — Infusion-reaction cardiotoxicity (mAb / CAR-T CRS / transfusion reaction / contrast)** (cardio.acute-hf.infusion-reaction-cardiotoxicity.v1).
Scope: Peri-infusion cardiotoxicity = symptom onset within minutes-hours of biologic / CAR-T / blood / contrast infusion. Four phenotypes: mAb infusion reaction, CAR-T CRS, transfusion reaction (TRALI / TACO / hemolytic / anaphylactic), contrast reaction. CRITICAL FIRST STEP: STOP THE INFUSION immediately + maintain IV access. Cause-specific antidote: tocilizumab for CRS; epinephrine for anaphylaxis; diuretic for TACO; ventilatory support for TRALI; supportive for mAb infusion reaction.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Infusion-reaction cardiotoxicity — STOP infusion + cause-specific antidote (tocilizumab CRS; epinephrine anaphylaxis; diuretic TACO; respiratory support TRALI) + supportive ADHF bundle (ASH 2024 + Lee CRS PMID 24876563 + WAO 2020 anaphylaxis + AHA cardio-onc 2022 PMID 35403432)**.
1. tocilizumab 8 mg/kg IV (max 800 mg) repeat q8h up to 4 doses IV q8h up to 4 doses (anti_il_6_receptor_monoclonal_antibody, first line) — Lee CRS PMID 24876563 + Ganatra JACC CardioOnc 2020 + ASCO/SITC CRS guidelines — anti-IL-6R first-line for CAR-T CRS grade ≥2 with end-organ involvement; reduces cardiotoxicity progression
2. methylprednisolone 125 mg IV (anaphylaxis or refractory CRS) or 1 mg/kg IV daily for CRS escalation IV as needed for anaphylaxis; q6-24h for CRS (systemic_corticosteroid, first line) — WAO 2020 anaphylaxis + ASCO/SITC CRS — corticosteroid adjunct for anaphylaxis (after epinephrine) and refractory CRS (after tocilizumab); dexamethasone alternative 10-20 mg IV q6h
3. epinephrine 0.3 mg IM (1:1000) repeat q5-15 min; or 0.05-0.5 µg/kg/min IV infusion if persistent shock IM/IV q5-15 min IM; continuous IV if shock (alpha_beta_adrenergic_agonist, first line) — WAO 2020 anaphylaxis Class I — epinephrine FIRST-LINE for anaphylaxis with cardiovascular / respiratory compromise; IM thigh preferred over SC; IV infusion if refractory hypotension
4. diphenhydramine 25-50 mg IV IV q4-6h up to 24h (h1_antihistamine_first_generation, add on) — WAO 2020 — H1 blockade adjunct after epinephrine; reduces urticaria + pruritus + bronchospasm contribution
5. famotidine 20 mg IV IV q12h (h2_antihistamine, add on) — WAO 2020 — H2 blockade in combination with H1 superior to H1 alone for hypotension reversal
6. furosemide 40-80 mg IV bolus then 5-10 mg/h infusion if needed IV as needed (loop_diuretic, first line) — DOSE PMID 21366472 — standard ADHF diuresis; first-line for TACO; NOT helpful for TRALI (TRALI is non-cardiogenic permeability edema)
7. norepinephrine 0.05-0.5 µg/kg/min titrate to MAP ≥65 IV continuous (vasopressor_alpha1_beta1, first line) — SOAP-II PMID 20200382 — first vasopressor for refractory cardiogenic + distributive shock; useful adjunct after epinephrine for anaphylaxis with persistent hypotension
8. lactated Ringer crystalloid 1-2 L IV bolus over 20-30 min IV as needed; cautious in cardiogenic component (isotonic_crystalloid, first line) — WAO 2020 anaphylaxis — IV crystalloid bolus for anaphylactic hypotension; cautious in concurrent cardiogenic component (TACO, CRS-CMP) — start with 250-500 mL bolus and reassess
9. acetaminophen 650 mg PO 30-60 min before infusion PO pre-infusion (analgesic_antipyretic, first line) — Standard premedication for at-risk infusions (rituximab, paclitaxel, IV iron, gadolinium); reduces febrile reaction component
10. hydrocortisone 100 mg IV 30-60 min before infusion IV pre-infusion (systemic_corticosteroid, first line) — Standard premedication for at-risk infusions; reduces severity of subsequent reaction
11. carvedilol 3.125 mg PO BID titrate PO BID (beta_alpha_blocker, first line) — GDMT once stable; CAPRICORN PMID 11356436 + ESC cardio-onc 2022 PMID 36017575
12. sacubitril-valsartan 24/26 mg PO BID titrate PO BID (arni, first line) — PIONEER-HF PMID 30403955 + ESC cardio-onc 2022 Class IIa
13. spironolactone 12.5-25 mg PO daily PO daily (mra, first line) — RALES PMID 10471456 + ESC cardio-onc 2022 Class I
14. empagliflozin 10 mg PO daily PO daily (sglt2_inhibitor, first line) — EMPULSE PMID 35347356 + ESC cardio-onc 2022 Class IIa

Setting playbook (outpatient) — Long-term cardio-oncology / cardiology surveillance: serial echo at 3, 6, 12 months for CRS-CMP / mAb cardiotoxicity reversibility; ICD evaluation if persistent LVEF <35% on full GDMT; allergy/immunology long-term follow-up for premedication + alternative agent recommendations; blood-bank surveillance if TRALI; mental health follow-up if traumatic experience
15. continue 4-pillar GDMT until LVEF normalized + stable ≥6-12 mo (avoid TRED-HF withdrawal harm) ARNI + BB + MRA + SGLT2i at max tolerated PO as scheduled — Persistent HFrEF (TRED-HF PMID 30429051; ESC cardio-onc 2022)
16. maintain epinephrine auto-injector if anaphylaxis confirmed epinephrine 0.3 mg IM auto-injector refill IM as needed — Confirmed anaphylactic risk (WAO 2020)

Non-pharmacologic actions:
- Cardio-oncology / cardiology clinic q3-6 mo
- Allergy/immunology annual
- Cardiac rehab maintenance if HFrEF
- ICD evaluation if LVEF <35% at 6 mo on full GDMT
- Future infusion premedication maintenance
- Mental health follow-up if traumatic reaction experience

AVOID / contraindication checks:
- STOP_infusion_immediately_for_any_acute_cardiopulmonary_decompensation_during_or_within_hours (cornerstone for all 4 phenotypes)
- Tocilizumab_first_line_for_car_t_crs_grade_2_or_higher_with_cardiotoxicity (Lee CRS PMID 24876563 + ASCO/SITC)
- Epinephrine_im_first_line_for_anaphylaxis_with_cardiovascular_or_respiratory_compromise (WAO 2020 Class I)
- Diuretic_NOT_helpful_for_TRALI_only_for_TACO (TRALI is non cardiogenic permeability edema; furosemide may worsen pre existing volume status)
- Cautious_crystalloid_bolus_if_cardiogenic_component_dominant_start_with_250_to_500ml (TACO + CRS CMP make full anaphylaxis bolus risky)
- Premedicate_at_risk_infusions_with_acetaminophen_diphenhydramine_corticosteroid_30_to_60min_prior (rituximab, paclitaxel, IV iron, gadolinium)
- Slow_infusion_rates_with_stepwise_escalation_for_first_dose_mab (first dose dominant for mAb CRS)
- Blood_bank_notification_for_TRALI_donor_exclusion_and_alternative_transfusion_strategy (washed RBC, male only plasma per AABB)
- Switch_to_ferric_carboxymaltose_or_ferric_derisomaltose_for_chronic_iv_iron_need_to_reduce_reaction_rate
- Pre_emptive_tocilizumab_for_high_risk_repeat_car_t_cycles (recent guideline updates)

Monitoring

Regimen monitoring:
- continuous telemetry and arterial line if shock
- serial troponin at presentation 6h and 24h for myocardial injury pattern
- daily nt probnp and lvef with strain for recovery tracking
- daily lfts and bilirubin for crs hepatotoxicity or cytokine storm
- daily cbc for crs cytopenias or hemolytic reaction evolution
- q6h glucose during steroid phase
- continuous pulse ox for TRALI TACO respiratory pattern
- tryptase within 3h of anaphylaxis onset to confirm mast cell mechanism
- cytokine panel il 6 trend after tocilizumab for response tracking
- echo at 24 to 48h for reversibility of crs cmp or takotsubo pattern
- allergy immunology written report for chart with premedication recommendations
- blood bank investigation results within 48h for donor exclusion

Setting (outpatient) monitoring:
- Quarterly clinic visits + echo if HFrEF
- Annual NT-proBNP + troponin
- Cancer / autoimmune surveillance per primary specialty

Follow-up plan: Cardio-oncology / cardiology follow-up at 2 wks + 6 wks + 3 mo with echo (LVEF reversibility for CRS-CMP); allergy/immunology consult for premedication protocol + future infusion guidance + alternative agent recommendation; for transfusion reactions: blood-bank donor exclusion + future transfusion strategy (washed RBC, male-only plasma); for repeat CAR-T → CRS prophylaxis with pre-emptive tocilizumab in high-risk; iron-deficiency anemia switch to slow IV iron formulations (ferric carboxymaltose / ferric derisomaltose); patient + family education on early reaction recognition
- Close-out criterion: cardio-oncology + allergy/immunology + blood-bank pathway booked

Monitoring phase: Continuous telemetry + arterial line if shock; serial troponin q6h × 24h; daily NT-proBNP; daily echo with strain × 48h; daily BMP + LFTs (CRS hepatotoxicity); cytokine trend if tocilizumab given; respiratory monitoring (TRALI / TACO); blood-bank investigation results; allergy/immunology written report for chart

Disposition

Current setting: outpatient — Long-term cardio-oncology / cardiology surveillance: serial echo at 3, 6, 12 months for CRS-CMP / mAb cardiotoxicity reversibility; ICD evaluation if persistent LVEF <35% on full GDMT; allergy/immunology long-term follow-up for premedication + alternative agent recommendations; blood-bank surveillance if TRALI; mental health follow-up if traumatic experience

Disposition criteria:
- Long-term continuation; cross-link to cardio.hfref.core.v1 if HFrEF persists past 12 mo; allergy/immunology survivorship lifelong

Escalation triggers (move to higher acuity):
- Worsening LVEF despite GDMT → advanced HF evaluation
- Recurrent reaction at any future infusion → emergent allergy/immunology + cardio-oncology
- Cancer progression requiring restart of cardiotoxic agent → joint cardio + onc shared decision with intensive premedication and pre-emptive tocilizumab if CAR-T
- ICD therapy delivered → urgent EP

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] CAR-T patient with CRS grade 3-4 (high-grade fever + hypotension requiring vasopressor + hypoxia requiring O2 ≥40%) + new cardiac decompensation (troponin elevation, LVEF drop, takotsubo pattern) — STAT tocilizumab + steroid + ICU + advanced HF consult
- [LIFE_THREATENING] Patient within 6h of blood transfusion with hypoxemic respiratory failure + bilateral infiltrates + no JVD/HTN (TRALI pattern) + PaO2/FiO2 <200 — intubation + lung-protective vent + AABB notification
- [LIFE_THREATENING] Anaphylaxis with cardiac arrest OR refractory hypotension despite IM epinephrine × 3 + crystalloid bolus 1-2 L — IV epinephrine infusion + ICU + ECMO consideration

Citations

- ASH 2024 transfusion reactions + Lee CRS PMID 24876563 + ASCO/SITC CRS guidelines + WAO 2020 anaphylaxis + AHA cardio-oncology 2022 + ESC cardio-oncology 2022 [PMID:24876563](https://pubmed.ncbi.nlm.nih.gov/24876563/)
- Cited evidence (PMID 35403432) [PMID:35403432](https://pubmed.ncbi.nlm.nih.gov/35403432/)
- Cited evidence (PMID 36017575) [PMID:36017575](https://pubmed.ncbi.nlm.nih.gov/36017575/)
- Cited evidence (PMID 35363499) [PMID:35363499](https://pubmed.ncbi.nlm.nih.gov/35363499/)
- Cited evidence (PMID 34447992) [PMID:34447992](https://pubmed.ncbi.nlm.nih.gov/34447992/)

Last reconciled with current guidelines: 2026-05-15.
References
  • ASH 2024 transfusion reactions + Lee CRS PMID 24876563 + ASCO/SITC CRS guidelines + WAO 2020 anaphylaxis + AHA cardio-oncology 2022 + ESC cardio-oncology 2022 — PMID:24876563
  • Cited evidence (PMID 35403432) — PMID:35403432
  • Cited evidence (PMID 36017575) — PMID:36017575
  • Cited evidence (PMID 35363499) — PMID:35363499
  • Cited evidence (PMID 34447992) — PMID:34447992