Development of Jaundice like syptoms in thal patients

Hi!

      My daughter was recently transfused.. everything went smoothly until the next day. she turned all pale( dark yellowish) colored eyes and skin the symptoms were same as in hepatitis -A virus ( jaundice). I rushed to hospital worried that she has got the virus. Doctor at the hospital told us to have the following tests done..

- Blood Complete Picture (CP).
- Cooms ( Direct and Indirect).
- LFT( liver function test (direct and Indirect)).
- Reticulocytes Count.

  To our luck Cooms test was negative and Reticulocytes Count were normal. the only thing that was not normal was the LFT( liver function test). Following are the stats

                                                                  Normal Ranges

   

     -Total Bilirubin                18.5 mg/dL         0.2 - 1.0 ( Adult )
                                                                               < 12.0  ( Neonate )
         -Direct Bilirubin                 6.8  mg/dL          0.0 - 0.25
   
         -Indirect Billirubin                  11.7  mg/dL        0.1 - 0.75 ( Adult )
                                                                                   < 11.75 ( Neonate )

   -SGOT ( AST )                   26  U/L           9 - 40

   -SGPT ( ALT )                  10  U/L            9 - 40

   -Alkaline Phosphatase            151 U/L          Adults   30 - 115
                                                                                  Upto    15 Years  <345 
                                                                           15  to   17 Years  <483


   As you can see the bilirubin levels are pretty high as in Hep-A virus but the doc said teh SGOT and SGPT values are low so it is not Hep-A and the resultant jaundice symptoms are due to the breaking of RBC's    Could anyone please highlight why this is presented like this.

         Anyhow the symptoms went away after two to three days and she is fine..    What i would like to know is

-  Why does this happen and what does it mean is it a good thing or bad??
-  how can it be avoided ?
-  Does this happen because of any sort of negligence during the blood screening / cross matching process?
-  What effect is there on the Hb of the patient due to this?

Thanks

Hi Mrtariqkhan,

Bilirubin is the waste product of heam (part of heamoglobin). Don't worry, most thals have increased bilirubin. The only risk can be gallstones in future. This is a commun problem especially in thal intermedia.

Somtimes bilirubin dercrease by regular blood transfusion (hb should not drop to 9g/dl, pretransfusional Hb should be arround 10 g/dl.)

I don't know why this happend one day after transfusion. It could due to an intollerance of transfusion. Was it an red packed cell or was the blood filtered befor? It is recomanded that it should not pass more than three days from tha bloodletting to transfusion for thals.
More time pass more earlyer the red cell break down.

Hope it help you

It is recomanded that it should not pass more than three days from tha bloodletting to transfusion for thals.
More time pass more earlyer the red cell break down.

Does this make a big big difference?,I mean shall i go to blood bank people and request personally to deliever the blood drawn in last three days for my daughter,bcoz it doesn't happen always?

ZAINI.

Hi,

It's very unlikely that it will happen here where there is already shortage of blood. So, banks tend to issue blood by the "First in First out" rule so that the blood with max validity stays in stock for the longest period of time.

Oh well, You can't get everything in life, we are just thankful that we are getting blood in the first place.

Take care, Peace!

Yes, the reason for the yellow color and high bilirubin is the excess hemolysis or break down of the transfused red cells. This happens because antibodies in the blood react to the antigens in the donor blood. These antibodies are increased in the blood due to previous transfusions. The more one is transfused, the more one accumulates these antibodies. This is why using a filter or filtered blood is so important. Removing the white cells and the antibodies contained in them is very important in improving the survival of the transfused red cells and also avoiding transfusion reactions. As you suggested, accurate cross matching is also a very important factor in avoiding excessive hemolysis.

If at all possible, use a filter during transfusion. One other thing that may help is using prednisone along with the transfusions. This can help counteract the immediate antibody reaction and lead to longer life for the transfused red cells. Perhaps Sharmin can share her experiences with her son regarding this.

Thanks Mr. Andy

Does this make a big big difference?,I mean shall i go to blood bank people and request personally to deliever the blood drawn in last three days for my daughter,bcoz it doesn't happen always?

ZAINI.

Hi Zani,

It will make a notavel difference if you get fresh blood or if the bloodlettig was 14 days ago. For a "healthy"  who need transfusion after a big surgery it is not important because he has a healthy blood system and within a few day his bone marrow will reproduce the lost blood. This will not happen in thals.

At the other way we can be happy to recive blood. Sometimes it is not possible to get this fresh red cells so it is ok to recive what is disponible.

Hi Gabri,

Thanx for replying, i never knew that thing about blood,so whenever at hospital on transfusion day,the staff told me the collection date and the expiration date, i always thought that it's good to be confirmed that the blood is not expired,but i never counted the days from collection till transfusion,but this time when we went for transfusion i noticed the date ,it was about 15 days old, it is really concerning me,i don't know what should i do, go to the blood bank people and request them for freshly collected blood for my daughter's transfusion,but i highly doubt they'd respond positively,so for the moment i think it's better to let things be as they are.

ZAINI.

Hello Mr. Tariq,

Sorry I couldn't go to JSF earlier as the weather had been quite bad lately. However, yesterday I went to JSF as I had an appointment and the weather had calmed down too.

I asked the doctor about your baby having Jaundice after the TransX. She asked to check some attribute in the Blood CP (which I forgot, sorry). If that was normal then she said that it is unlikely that she got a reaction from the blood and the jaundice could have been triggered by Hep-A virus. I asked her about using the filter and she said that using the filter is could not prevent it.

I think she said that because Hep A is most commonly transmitted via oral tract which she received some time before the TransX and eventually gave her the symptoms later.

Take care.

Hi,

   Thanks for the update...  Well, i took her to a couple of specialists and Hep-A virus doesn't go away in a day or two.... i know coz i have suffered from it once  ... (Took me 1 and half month to recover completely)

   I think the best and conclusive answer to what happened is the reply from Andy:

Yes, the reason for the yellow color and high bilirubin is the excess hemolysis or break down of the transfused red cells. This happens because antibodies in the blood react to the antigens in the donor blood. These antibodies are increased in the blood due to previous transfusions. The more one is transfused, the more one accumulates these antibodies. This is why using a filter or filtered blood is so important. Removing the white cells and the antibodies contained in them is very important in improving the survival of the transfused red cells and also avoiding transfusion reactions. As you suggested, accurate cross matching is also a very important factor in avoiding excessive hemolysis.

If at all possible, use a filter during transfusion. One other thing that may help is using prednisone along with the transfusions. This can help counteract the immediate antibody reaction and lead to longer life for the transfused red cells. Perhaps Sharmin can share her experiences with her son regarding this.

    So i am and the docs are pretty convinced that it wasn't Hep-A virus infection.  as the SGPT values were pretty low, they are the main indication for Hep-A virus

  Anyhow, I will talk to them again in this regard and act on advice of Andy and use ( Filter and Prednisone) so as to retain the life of RBC's .


Thanks Again
Take Care