Hi friends,
i
f bi monthly was such a beneficial thing, then why would world wide doctors prescribe it monthly or when the body needs, there has to be a catch to it or else all the kids would have gone thru bi monthly.
I think that this standard is used for a few reasons - one is so that patients do not receive unlimited volumes of blood - so 4 weeks and a level between 9 - 10 has been adapted - also for consistency between different hospitals and centers. Also, being that around fours weeks is also the life span of red cells it makes sense that way too.
However, some of the prominent centers are recommending bi weekly transfusions - I have spoken with some parents being seen in New York - and they have told me that their doctors have recommended txs every 2 weeks for optimal health. These parents have also said that they have had no complications with their children and their children are never tired because they are never low. Numerous patients in my city also elect to do this - some adults even come in for a small tx once a week because it works best with their work or university schedules. Some people prefer the more frequent txs because they find that their visits are shorter on any given tx day.
The other thing you can look at is exposure to more donors - I don't think you are getting exposed to more donors because after a certain weight (depending on the size of units) patients get more than one unit anyway. Therefore if you were to receive blood from a single unit with each transfusion - you are being exposed to the same number of donors. If a patient were to receive 8cc of blood per kg of their body weight every two weeks - then they would average 16cc/kg every four weeks.
The upside of this is that patients would not have symptoms of low hg, the red blood cells would not age all at once near 4 weeks post tx becoming less efficient (I am guessing that this actually happens), the body would marrow would not be active at all - so blood volume would not increase - (increased blood volume can lead to pulmonary hypertension). Also, with each transfusion you are giving a smaller volume of blood - so you are in fact putting less pressure on the heart by not changing the volume too much at once.
The negative effects would be - as Puja has mentioned - more pokes - veins getting tired from being poked more frequently because they haven't had a chance to rest. More days in the hospital, more cross match tests etc. Problems with standardizing what volume of blood each patient should have. Also, the emotional effect on children can be bigger if they are in the hospital more often - twice as much.
Doctor at the hospital once told me that if you transfuse a patient with hb of above 10,it puts pressure on heart which is not good,i don't know if it's entirely true,just sharing it.
From what I have been told, getting large volumes of blood at one time (greater than 20cc/kg) can put pressure on the heart. The hemoglobin itself does not affect it. If we think about it - within the first hour after tx begins the hemoglobin is above 100 - and then we continue to transfuse without causing damage to the heart (am I making sense?) So I can't see why transfusing while hg is above 100 can put pressure on the heart. I will ask our doctor though, maybe it is something that I am not able to understand. Our doctor often emphasizes that the less volume we transfuse at one time the less likely we are to increase the pressure on the heart. For this reason also, the smaller bi weekly transfusions may be good.
Also one time I came across a mother who said that the blood transfusion has to be done very slowly over a period of 6 hours or more, cos according to her the faster you give (in govt hospitals they are short of resourcres as in beds) the faster the hb comes down. Meaning if the transfusion has been given over a peiod of 4 to 6 hrs the next required blood transfusion requirement will be over a month and if it is faster then her daughter needed transfusion with in 21 days.
I think that this is true, because you are causing less damage to the red blood cells when you infuse them slower. Also, it is much easier on the body because you are increasing the volume slower. It is also good for people who have antibodies, slow rate, small transfusions.
And the head nurse told me that a bag of blood should be transfused with in 2 hours,or bacterias get developed in the blood,is that correct?
Zaini, the standard here is to hang a bag of blood for a maximum of four hours. After the four hours, they hang a new unit and change the tubing as well. Maybe there is a difference because of the process they use to store the blood.
My main reason to begin thinking about - bi weekly tx - is wondering what is best for our growing children throughout the month. Also, how to reduce pressure the the heart and lungs due to larger blood volumes.
My thought is that, if as the hg decreases below 100 - (an some retics can be found soon after the hg decreases below 98) - that the marrow may begin to increase the blood volume on top of that the kids get on big blast of transfused blood (15 - 20cc/kg) which can be 400cc+ in these little children (for my son it is around 534cc). I worry that the increased volume (as small as it may be at this stage) that the body creates + transfused blood volume - may put pressure on the heart.
Also, in the week before tx - the small amount of retic ing that the kids may do (it tends to be very little in thal majors 2% to 8% retics at this stage) and the increased hemolysis during this time may put the kids at some risk of fragments building up over time.
I can see that most people do well with the four week schedule - but if there is room for improvement and general well being maybe this is worth discussing with our doctors. I will ask Oakland during our next visit.
I think my post has gotten pretty long.....so I had better sign off
Sharmin