Transfusion reactions other than TRALI

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Transfusion reactions other than TRALI
« on: April 19, 2006, 03:52:24 PM »
It happened to me again! :pissedoff

Today, during halfway through the transfusion I noticed red itchy blotches all over my body and this time I had no trouble breathing as before; which I previously thought(In Danielle's TRALI thread) that I was experiencing TRALI.

I called the staff nurse and he came back with that dreaded Avil Inj. :shocked . Amazingly today it didn't hurt a bit and I felt no side effects as previously stated in the TRALI thread. I also noticed that it wasn't working too as I didn't feel the itchy blotches getting better.

Near the end of the Transfusion I noticed some Plasma floating above the red cells and I thought to my self that I won't let that go in as it probably contained all that gunk(like Poirot said :biggrin) my body reacted to.

Meanwhile three medical students came and asked me for their research interview, I got distracted in that and forgot to stop the transx. before the plasma went in. Anyway I didn't feel anything unusual for sometime and when my attendant came to take me home; Avil kicked-in :banghead .

Thank God I was besides the bed and lied down as my vision started to blacken and my ears started buzzing. I could hardly hear my attendant asking me if anything was wrong. He got worried and called the nurse who just said "Don't worry, this is just the effects of Avil." He just ignored it while I wondered why did Avil kicked in late after about an hour or so? Was the high concentration of gunk in the floating plasma caused Avil's reaction? as there was no reaction till the red cells lasted in the bag.

After a rest of an hour or so I recovered and came home.

Please feel free to share your own experiences
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Re: Transfusion reactions other than TRALI
« Reply #1 on: April 20, 2006, 03:43:08 AM »
Hi
I have seen plenty of transfusion reactions in my experience.

When the cross matching is done in India ( even maybe in Pakistan), all the parameters are not matched as  maybe in Australia , Uk or the USA. We do not have a highly sophisticated testing system.

 Moreover, due to frequent transfusions you may develop some antigens which can react even though the cross matching has been done. Just any one component of the blood might cause such a reaction.

Then again if one is not using filters, reactions can happen. But usually, when red blotches or Riger takes place, they shut down that blood.. because you are reacting to that blood. It is not because of the plasma.. in any case even if you are getting packed cells, some  amount of plasma is bound to be present in the blood.

Then some people react if the blood is too cold or if the blood is going too fast..

Yes Avil when given intra-veinously can cause such an effect.. speech gets blurred, u feel you are sinking..
I have seen doctors pushing Deriphilin when there is a bad red-blochy reaction.
With rigers and fever, normally Crocin ( Paracetamol) and Phernargan are given by mouth.

I think you should check with your doctor, if the blood should be continued when you get such a reaction.


Shikha mitra

Re: Transfusion reactions other than TRALI
« Reply #2 on: April 20, 2006, 04:42:25 PM »
Hey
 I had meant anti-bodies and not antigens in my previous post.... sorry for the mis-spell!

shikha mitra

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Offline Poirot

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Re: Transfusion reactions other than TRALI
« Reply #3 on: April 27, 2006, 07:10:28 PM »
my vision started to blacken and my ears started buzzing. I could hardly hear my attendant asking me if anything was wrong. He got worried and called the nurse who just said "Don't worry, this is just the effects of Avil." He just ignored it while I wondered why did Avil kicked in late after about an hour or so? Was the high concentration of gunk in the floating plasma caused Avil's reaction? as there was no reaction till the red cells lasted in the bag.

Yeow, dude, you got to take care .... that's serious shit happening to you.

Can you find out about one point - are you getting whole blood or packed cells??? (BTW, Blood Plasma, separated out, is yellow in colour.) I have never received whole blood .... so, don't know whether it looks very different from packed RBCs. But, you should not be getting whole blood, in any case .... too much volume, with the plasma and WBC being useless and causing all the reactions.

Take care,

Poirot
« Last Edit: April 27, 2006, 07:19:48 PM by Poirot »

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Offline Poirot

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Re: Transfusion reactions other than TRALI
« Reply #4 on: April 27, 2006, 07:18:48 PM »

When the cross matching is done in India ( even maybe in Pakistan), all the parameters are not matched as  maybe in Australia , Uk or the USA. We do not have a highly sophisticated testing system.


You are wrong.

Maybe, the centre you are at is problematic, but please do not tar all thal centres with the same brush. I would invite you to visit the Indian Red Cross centre in Mumbai and see for yourself a well run thal centre. In the last six months, I can not recall anyone at my centre being given Avil or Crocin or whatever for a tx-related reaction. This is because we have good technicians, who take pride in their work and care for the thal patients at the centre. Maybe, your centre lacks adequately trained technicians?

By denigrating thal care in India, you only serve to depress other Indian parents in this group into thinking that they can not get adequate care in India. Sure, there are problems, but there are solutions too. And, stuff that happened 10-15 years back are irrelevant. It is the here and now that we should be concerned about - and the truth is that the here and now is improving.

Ok, off my soapbox now.

Poirot


 

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Re: Transfusion reactions other than TRALI
« Reply #5 on: April 28, 2006, 04:51:59 AM »
Can you find out about one point - are you getting whole blood or packed cells??? (BTW, Blood Plasma, separated out, is yellow in colour.) I have never received whole blood .... so, don't know whether it looks very different from packed RBCs. But, you should not be getting whole blood, in any case .... too much volume, with the plasma and WBC being useless and causing all the reactions.

Hi Poirot,

             I get packed RBCs (well, poorly processed RBCs). Because when the transfusion begins, it is all mixed up and completely red, but as time passes the poorly removed plasma floats up as it is lighter than RBCs ( see Physics books for liquids of different density :biggrin).

             I guess my Thal. center isn't the Hi-tech one. I won't be surprised if they centrifuged the blood by.... Oh, forget it :whyme :sigh
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Offline Poirot

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Re: Transfusion reactions other than TRALI
« Reply #6 on: April 28, 2006, 05:52:37 AM »
I get packed RBCs (well, poorly processed RBCs). Because when the transfusion begins, it is all mixed up and completely red, but as time passes the poorly removed plasma floats up as it is lighter than RBCs

Jeez, you can see the plasma, by the time the transfusion ends??? Can you not complain or is that not an option?
One reason this could be happening (apart from inadequate time in the centrifuge, which I would doubt) is that your technicians may not be draining off all the plasma, to ensure that all the RBCs remain in the bag. Since, RBCs are the precious good in this case, they may be opting to retain 100% of the RBC along with 1% of the plasma. Our technicians here drain off the top portion of the RBCs, too, to reduce the chances of any plasma remaining behind. So, we get 99% of the RBC with zero plasma. Then, they wash it.

Have a chat with your technicians and see what they say about the plasma in the bag.

Cheers

Poirot

Re: Transfusion reactions other than TRALI
« Reply #7 on: May 08, 2006, 06:04:07 PM »
Supratim

I don't think I have ever tried to denigrate the medical system in India in any of my postings.
You are one of the many lucky ones to be able to afford the treatment and to get the best of doctors ( Dr. M.B. Agarwal for instance, who is undoubtedly one of the world's  best expert in Thal). And I too will remain  ever grateful to Dr. Agarwal for putting my daughter where she is today and for teaching me what Thal was all about. But not everyone is  that fortunate in India or in other similar countries .

Sometimes there are no supervising doctors when the transfusions are going on,( my own experience )  and the kids are at the hands of the Nurses, who dont have a clue what Thalassaemia is and God forbid if a reaction takes place and again God forbid if the parent accompanying the child dont know enough about Thal.And this is not 15 years ago.. but NOW. Ask Shilpa, Simran..... ( from Pune)

Most transfusion reactions are due to the handling and processing of the blood...... and if the testing system was so good, then how come you or my daughter ( when testing for Hep C was available in India)  landed up with Hep C? Have we been able to rule out Hep C  or HIV through transfusion even in 2006?

And it is not that India do not have good technicians, it is just we do not have the resourses
And this is the condition of most blood banks in India.
You are lucky to be in Mumbai .
As for proper treatment in India, I have always harped against the huge cost of the treatment and not always the quality. The cost is just unaffordable and if you cannot afford the cost of an adequate treatment, then how can we talk about attitude? How many adult Thals in India are leading a near normal life except a lucky few?

shikha mitra


« Last Edit: July 15, 2007, 03:45:04 PM by Andy »

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Offline Poirot

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Re: Transfusion reactions other than TRALI
« Reply #8 on: May 22, 2006, 11:28:10 AM »
Shikha,

I don't want to flame you, and so, I will try to be as moderate as I can be in my reply.  :biggrin I think you have this misconception that I am a very lucky, very rich person, and hence, my experiences do not apply to the "real" India. Nothing could be further from the truth. My parents were middle class and did not have loads of money for treatment - but they economised on loads of other stuff and we managed. My father's office did not pay for the blood tx, although it did pay for my splenectomy. I met Dr Agarwal for the first time when I was 15 years old .... so, it is not like he was taking care of me from the start. And, even after that I think I have consulted him maybe once a year, or less. My family doctor was a gem, though .... she took it upon herself to learn as much as she could about thal to treat me - I was her first thal patient. So, I owe her much more than I owe Dr Agarwal. However, from the age of 15-16, I started learning as much as I could about thal, so that I could be as knowledgeable as any doc, at least as far as the main points go. In many ways, I started taking decisions about my own health with the information that I gained. That built up my confidence to take on the external world. Even though I was a thal, I was pretty boisterous ... never shied away from a fight whether physical or verbal at school, then college!!! It's all to do with building up confidence ......

When it was time for work, I did not act "honest", I acted "smart" ..... first, I short listed places of work in my city, so that I could still use my home and home facilities, then i shortlisted firms that did not need a medical test for their jobs (many did not, since they were not providing insurance) and then I started interviewing. I got a job and proved my creds ..... later, it did not matter if i had to take a medical test and told them that i had thal .... i had already proven i could do the job. Why did i not tell my employer that I had thal? (infact most of my employers never knew, and in the final analysis, did not care) My thinking was that there was no potential benefit to me, only potential downside, so what was the point? Ashish, on the other hand, will tell you a different story .... he has always disclosed upfront and has not suffered for it, in fact he has been able to swap his holidays to suit his tx schedule .... so you have two diff approaches, but both with similar end results. Yes, your daughter had a diff result, but I am sure that was a temp setback.  Today, you may consider me to be well-off, but this is not because my parents were wealthy, but because I earned it. With the support of my wife and parents, of course. But, I earned it. And, that is the point I was trying to convey. It is important to convey a positive message to all thals in India, even if their current ground reality may be difficult. Because, it may not always be that way ..... Because, we, the thals, can change our reality.

I accept that care is expensive and many can not afford it in India. The solution is to provide financial help. Cipla has done this by making chelation available much more cheaply than before. And, this is the point I was making to some of the TIF India people at the Pune conference .... that, one of the most important, if not the most important, activity for the federation has to be raising money. But, they don't get it. They are still stuck in a time warp. If people in Pune can not afford the cost of care, why don't YOU form a group to help raise money for them? I am sure Shilpa, Simran and all the other thals in Pune will be glad to help you .... why moan that things are not available .... why not do something to make it available? But, even TIF India has a curious frog in the well mentality .... they don't want to explore ... do things differently, and hey, you may just find a solution. When Ashish and I talked about how it is now possible to get hospitalisation insurance in India for thals, at the Pune conference, you saw the response ..... condemnation without enquiry. And, we were stating facts. Imagine what would have happened if we had talked about doing something more adventurous ......

My only exhortation to Indian thals is to dream big and build up your own self esteem. You are living in 2006, not 1976. If I could flourish in the last 30 years, forget just survive, then you have no excuse not to do even better. You can overcome all adversity with support .... and you will get support, if you ask for it, if you demand it ....But, you have to do your bit, too .... not expect to be spoon-fed everything.

Now, re: Hep C - I believe I got infected about 15 yrs back (based on the viral load). Those days the tests were just not available. And, not just here in India, but in the US, too. Don't know whether you are aware, but Lisa had Hep C, too. I wonder how she managed to get infected in this leader of the free world, super rich, great first world country???? Yes, your daughter has got a better life in the US than she had in India, but to use that one example to say that you can not have an equally good quality life in India is wrong. For every example that you can give me a well-adjusted thal in the USA, I will give you one in India, too. [[Rude comment removed by author]]

Don't get me wrong ... I think you went through a lot of trauma, and I am not belittling that. But, a lot of us went through that, too, and are now better, stronger people for it. Sure, lots of our friends did not make it, but it was harder then. It is easier now. And, if we could do it then, every single thal can do it today. And, that is the cause for my optimism.

Cheers



 




« Last Edit: July 15, 2007, 03:46:19 PM by Andy »

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Offline Andy Battaglia

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Re: Transfusion reactions other than TRALI
« Reply #9 on: May 22, 2006, 02:38:12 PM »
Just a small point. Lisa contracted hepatitis in 1992, one year before testing began. Just a case of very bad luck.

I will also point out that because of the rarity of thal in the US, that in many parts of the US, it is unknown and unrecognized when encountered. A patient may be very much better off in Mumbai than Montana.

Andy

All we are saying is give thals a chance.

Re: Transfusion reactions other than TRALI
« Reply #10 on: May 23, 2006, 03:02:22 AM »
Supratim

There is really no question of "heating me up".. You are probably my daughter's age and I know what your parents must have gone through in 1976-77.....we were probably in the same boat.
I have never disputed the fact that things are much much better now and there is always a way when there is a will.
I felt really happy  and proud to see people like you and Ashish, simran, shilpa.... at the Thal conference in Pune.
But I feel more happy and proud for people like your wife and my son in law , who give all the support and love, which is still a rarity in India - to really care and accept the person for who he or she is .

Like you, my daughter has also  learned the hard way and in a way she has become her own doctor too.It was also not easy for her. Whatever she has achieved today is totally her own and I take no credit for that except that I never treated her any differently.

You must be aware, even in the USA, education is not easy if you dont have insurance.. specially with Thal.. and no insurance company will cover you with a pre-existing condition. So it was a real fight against all odds and as I said if you really try, something does come up.So please do not think that she came here for better medical facilities or I had plenty of wealth to shower on her.. She came here for higher education in the first place and totally on her own with a good funding from the University.
If the  Sickle Cell center of North Carolina were not kind enough to take her in and help her, she could not have gone to the USA.And this just didnt fall into her lap.. she had to work hard for it.

As for me, I think in my own way I did my best to spread an awareness by writing articles in the newspapers in Pune ( in fact Shilpa once read out one of my articles at a Thal conference, as now I have moved from Pune), to talk to some of the gynaecologists into making testing for Thal mandatory for each pregnancy, giving interviews etc. My daughter was featured several times in both Indian Express and The Times of India.
Infact the first Thal. Association of Pune was started by my husband and another gentleman ( Mr. Thadani) who was present at the Pune conference.

So my postings are never to attack you or the Indian system in any way, nor have I tried to say that all things in the USA are the BEST, nor do I not make any effort to help in my own small way. But now when I see the hospitals in the USA and their methods, I realise that I could not have given my daughter the same back in India. Here you are  also not discriminated  because of your health. If you have the talent and willing to work hard, the sky is the limit.

And if you think that my postings are a source of discouragement.. then too bad.. because if I didnt have the right attitude, I dont think I would have been able to raise a Thal child the way  I did and instill in her the right attitude.

Please know that as a mother and as a friend, I  understand each one of you, ...... your struggles, your despairs, your intelligence, your strengths.... and for the past 30 years I have learnt that life cannot be easy when one has to live on borrowed blood.  And I have seen that each day for the past 30 years and I am still seeing it.
I wish you all the very best always...

shikha mitra








..
« Last Edit: July 15, 2007, 03:47:14 PM by Andy »

Re: Transfusion reactions other than TRALI
« Reply #11 on: May 23, 2006, 03:29:53 AM »
Parents like you get their children down, I am afraid.

That is a very rude statement to make I think. I sincerely hope I have been able to express my feeling for all of you in my previous post.


shikha mitra
Shikha,

I don't want to flame you, and so, I will try to be as moderate as I can be in my reply.  :biggrin I think you have this misconception that I am a very lucky, very rich person, and hence, my experiences do not apply to the "real" India. Nothing could be further from the truth. My parents were middle class and did not have loads of money for treatment - but they economised on loads of other stuff and we managed. My father's office did not pay for the blood tx, although it did pay for my splenectomy. I met Dr Agarwal for the first time when I was 15 years old .... so, it is not like he was taking care of me from the start. And, even after that I think I have consulted him maybe once a year, or less. My family doctor was a gem, though .... she took it upon herself to learn as much as she could about thal to treat me - I was her first thal patient. So, I owe her much more than I owe Dr Agarwal. However, from the age of 15-16, I started learning as much as I could about thal, so that I could be as knowledgeable as any doc, at least as far as the main points go. In many ways, I started taking decisions about my own health with the information that I gained. That built up my confidence to take on the external world. Even though I was a thal, I was pretty boisterous ... never shied away from a fight whether physical or verbal at school, then college!!! It's all to do with building up confidence ......

When it was time for work, I did not act "honest", I acted "smart" ..... first, I short listed places of work in my city, so that I could still use my home and home facilities, then i shortlisted firms that did not need a medical test for their jobs (many did not, since they were not providing insurance) and then I started interviewing. I got a job and proved my creds ..... later, it did not matter if i had to take a medical test and told them that i had thal .... i had already proven i could do the job. Why did i not tell my employer that I had thal? (infact most of my employers never knew, and in the final analysis, did not care) My thinking was that there was no potential benefit to me, only potential downside, so what was the point? Ashish, on the other hand, will tell you a different story .... he has always disclosed upfront and has not suffered for it, in fact he has been able to swap his holidays to suit his tx schedule .... so you have two diff approaches, but both with similar end results. Yes, your daughter had a diff result, but I am sure that was a temp setback.  Today, you may consider me to be well-off, but this is not because my parents were wealthy, but because I earned it. With the support of my wife and parents, of course. But, I earned it. And, that is the point I was trying to convey. It is important to convey a positive message to all thals in India, even if their current ground reality may be difficult. Because, it may not always be that way ..... Because, we, the thals, can change our reality.

I accept that care is expensive and many can not afford it in India. The solution is to provide financial help. Cipla has done this by making chelation available much more cheaply than before. And, this is the point I was making to some of the TIF India people at the Pune conference .... that, one of the most important, if not the most important, activity for the federation has to be raising money. But, they don't get it. They are still stuck in a time warp. If people in Pune can not afford the cost of care, why don't YOU form a group to help raise money for them? I am sure Shilpa, Simran and all the other thals in Pune will be glad to help you .... why moan that things are not available .... why not do something to make it available? But, even TIF India has a curious frog in the well mentality .... they don't want to explore ... do things differently, and hey, you may just find a solution. When Ashish and I talked about how it is now possible to get hospitalisation insurance in India for thals, at the Pune conference, you saw the response ..... condemnation without enquiry. And, we were stating facts. Imagine what would have happened if we had talked about doing something more adventurous ......

My only exhortation to Indian thals is to dream big and build up your own self esteem. You are living in 2006, not 1976. If I could flourish in the last 30 years, forget just survive, then you have no excuse not to do even better. You can overcome all adversity with support .... and you will get support, if you ask for it, if you demand it ....But, you have to do your bit, too .... not expect to be spoon-fed everything.

Now, re: Hep C - I believe I got infected about 15 yrs back (based on the viral load). Those days the tests were just not available. And, not just here in India, but in the US, too. Don't know whether you are aware, but Lisa had Hep C, too. I wonder how she managed to get infected in this leader of the free world, super rich, great first world country???? Yes, your daughter has got a better life in the US than she had in India, but to use that one example to say that you can not have an equally good quality life in India is wrong. For every example that you can give me a well-adjusted thal in the USA, I will give you one in India, too. Parents like you get their children down, I am afraid.

Don't get me wrong ... I think you went through a lot of trauma, and I am not belittling that. But, a lot of us went through that, too, and are now better, stronger people for it. Sure, lots of our friends did not make it, but it was harder then. It is easier now. And, if we could do it then, every single thal can do it today. And, that is the cause for my optimism.

Cheers



 





« Last Edit: July 15, 2007, 03:56:00 PM by Andy »

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Offline Poirot

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Re: Transfusion reactions other than TRALI
« Reply #12 on: May 23, 2006, 09:00:38 AM »
Shikha,

Yes, that statement about you as a parent was rude and I apologise for it.
 
Reading your previous post, I think we are on the same page now about thal care and attitudes and upbringing. I think your past experiences with thal care in India made you frustrated about the quality of care in India and that started coming through as negative comments on the system here. Given that your daughter is now in the USA, I did not want those comments to depress other parents in India about the potential of care in India, especially since it has improved so much over the last 30 years. And, since I could see the changes myself first-hand. Hence, my previous critical comments. But, I understand where you are coming from now and appreciate your sentiments.

Peace.


Re: Transfusion reactions other than TRALI
« Reply #13 on: May 23, 2006, 02:39:05 PM »
 :smile2 :smile2 :smile2 :smile2 :smile2!!!!

 Thanks

shikha

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Offline Danielle

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Re: Transfusion reactions other than TRALI
« Reply #14 on: May 23, 2006, 06:42:51 PM »
Yay!  I thought I was going to have to separate you two into two different corners.  hahaha.  Just kidding.   :biggrin

Can we all hug now?   :bighug

I love you guys.  :wub

 

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