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ESA Priapism Erythrocytosis — ESENeph MCQ

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HardHaemodialysisESA Priapism ErythrocytosisESENeph

A 60-year-old man with CKD G5D on haemodialysis develops priapism. He has sickle cell trait but has never had sickle cell disease complications. His haematocrit is 42% after recent ESA dose increase. What is the likely cause?

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Correct answer: D — ESA-induced erythrocytosis increasing blood viscosity – priapism is a rare but recognised complication of ESA therapy when haemoglobin rises too rapidly or exceeds target

Priapism is a rare but recognised complication of ESA therapy, occurring when haemoglobin rises rapidly or exceeds target range, increasing blood viscosity. Patients with sickle cell trait may be more susceptible due to sickling tendency at high haematocrit. KDIGO 2025 anemia guideline recommends gradual Hb correction and not exceeding 130 g/L. This case illustrates why the upper Hb target matters. Management includes urological emergency treatment (aspiration/irrigation) and ESA dose reduction.

Reference: KDIGO 2025 – Anemia in CKD; Case reports in nephrology literature