This C.K.D patient has developed severe anemia which is a compensated hea failure state. The patient was given first unit of blood in two hours instead of standard four hours and he is already in compensated hea failure. The acute decompensation due to volume overloading that has subsequently occurred will result in pulmonary edema and shoness of breath. This presentation is called as transfusion associated circulatory overload. Ideally patients of CKD should be given erythropoietin injections to reduce the incidence of having severe anemia.