Are All Transfusions Equal?

An interesting discussion came up in a talk with my friend. Her Hb went up more than expected after her transfusion and she was wondering why. The question we came up with is are all transfusions equal or does it depend on the hemoglobin level of the donor? If you get a donor who has a high Hb will your Hb go up higher than normal when you receive that blood?   :wonder

This led to a discussion of super-donors, but that's another topic.   :winky

Hi Andy,

No, each transfusion is not equal.  It depends on a number of factors.  If the blood is not fresh, and is close to the date of expiration, there can be a lot of cell death.  Also, if the blood is washed, that also reduces the number of cells in the bag.  Each bag has a different amount of hemoglobin, so there will be times when it will only boost you up a little, and times when it will boost you up a lot.

I've had many instances where I had gotten two units of blood, and it didn't do much for me ... and then there are times when the units are so good that it gives me a nice enough boost to last the next two weeks without dropping so low.

I have also spoken to other Thals about male vs female donors, and many of us had come to the same conclusion.  Most of the time, when we have male donors, our Hgb goes up more than if we had a female donor.  This leads me to believe that it has a lot to do with the hemoglobin of the donor, since men tend to have a higher hemoglobin than women.   

Hello

I agree that all transfusions are not equal, besides the hemoglobin level and other factors discussed by Danielle it also depends on the quantity of blood you are recieving. Sometimes a donor can't give full bag and it is used as is. My daughter is getting less blood every five weeks because she has not enough weight to take on second bag but have enough weight to get extra half; unfortunately she is deprived of that half bag because the left over will be useless for others.

I knew I forgot something!   

Thank you, CF.  You are absolutely right.  The amount of blood in the bag is a huge factor!   

Hi Andy,

No, each transfusion is not equal.  It depends on a number of factors.  If the blood is not fresh, and is close to the date of expiration, there can be a lot of cell death. 

:d'oh I knew I wanted to reply to this post earlier but I FORGOT what I wanted to say :confused

Thank you very much Danielle for your post as it reminded me the incidient where I experienced this fact that I stated in my post in the "Living with Thal. What's your life like?" section.

My HB went down to 5 g/dl and after getting the regular refrigerated blood on Wednesday, not much improvement occured. Then they adviced me to get hyper-transfusions of fresh donated blood that I had to arrange myself!

So, the fresh blood is definitely better than refrigerated ones which are close to expiry.

Hi guys, its not the amount of blood in the bag matters, its the age of erythrocytes that matters. We understand normal life span of an erythrocyte is 120 days. That means in a blood bag there will be cells of diffrent ages. For some reason if there are so much neocytes ( new cells) in the blood bag there will be remarkable diffrence from that blood transfusion interms of maintaining hemoglobin level for longer period.

hi all

This is an interesting discussion and i have always wondered whether the lifecycle of the cell would affect our transfusion duration..

Mustho, i dont know how to put this question but as u say,

We understand normal life span of an erythrocyte is 120 days. That means in a blood bag there will be cells of diffrent ages. For some reason if there are so much neocytes ( new cells) in the blood bag there will be remarkable diffrence from that blood transfusion interms of maintaining hemoglobin level for longer period.

so, does that mean, for example if the most of the cells in the blood a donor donated has just started its life span, our hb will maintain for more longer period? and the older the cells are, our hb levels will go down sooner than expected?

and if thats the case, is there anyway to determine how old those cells (erythrocytes) are?

tc and cheers
  maako

Maako / Mustho

I will try to answer your questions, I think Mustho was right about the age of erthrocytes but to determine the age of such cells is quite difficult and expensive. If I remember correctly Canadian Blood Services had the experimental technology to obtain most recent erthrocytes from the blood by spinning technique but it deemed to be time consuming and expensive and was put on hold.

The normal blood has different age of erythrocytes as its a continuous process.

Mustho, amount of blood in a bag indeed is a factor in how successful the transfusion is, less amount of blood in a bag means less "erythrocytes" and ultimately if effects the duration of transfusion.

Regards

amount of blood in a bag indeed is a factor in how successful the transfusion is, less amount of blood in a bag means less "erythrocytes" and ultimately if effects the duration of transfusion.

I completely agree, CF.  They both have great significance. 

I agree amount of blood matters, I am not sure whether you guys have heard this, I read some where in UK they practice this to get neocytes. Bit of hematology : Erythropoiesis has various stages in the bone marrow, where recognizable hemoglobin formation starts at basophilic erythroblast, and after series of changes this blast comes  to peripheral circulation as reticulocyte. This is what we called neocytes definitely these cells will have more hemoglobin, capable of doing its major function that is to carry oxygen. i heard some hematologists prefer to use techniques to get neocytes to transfuse for thlassemics specially to prolong the transfusion intervals. I will do some more research on this and will write more on this.

What are "neocytes"?
         There has been quite a lot of talk about transfusing neocytes, so we had better explain what they are, and why people usually don't use them.
         We already explained that red blood cells are made in the bone marrow, and that each one lives for about 120 days (4 months). therefore the red cells in blood are all different ages, ranging from 1 to 120 days old. When you receive a blood transfusion, the older cells start to be destroyed right away. That is why you hemoglobin starts to fall again immediately after a transfusion.
         It is possible to partly separate younger red cells from older red cells, by special centrifuges or other methods. The younger red cells collected this way are sometimes called "neocytes". Because their average age is less than that of whole blood, they can last longer in the circulation. Some people have tried to use them instead of the usual kind of blood.
         In fact, neocyte transfusions do last slightly better than usual transfusions. The interval between transfusions becomes a little longer, rather less blood has to be given every year, and the amount of iron laid down in the body is reduced. So the idea of using neocytes is reasonable. However, people don't use them as a rule, because they give only a very small advantage, and it is so expensive and complicated to prepare them.

An absolute brilliant topic!

I have 2 boys, both majors and both have different level Hb pre-transfusion.
The older one's Hb is quite low, about 8.something and the younger maintains at about 9.0.

their pre-transfusion level used to maintain at or above 9.0 for both of them when they were in the paediatric unit. Both were given the exact amount of blood that their bodies required. Now however, at the adult unit, they are always given less than their body needs as the ward has a policy of not giving the last unit of blood if not more than 150mls was needed from it (a bag could average 270mls blood). They are usually not not transfused about 100ml each transfusion, sometimes less and sometimes more and this is usually for every monthly transfusion.

I'm sure that the freshest blood is used for each transfusion but i will need to ask. However, if each patient is given less blood than the body needs in every transfusion, would this not impact the body negatively? Does this have an impact on the heart and stress on the bones? The older thals on the unit have complained about tiredness but they accept this policy.
Wouldn't it make sense to give the full amount of blood that the body requires. If it leads on to other issues that would mean more appointments, more treatments if needed; medication resulting in more money spent on each thal patient.

I'm annoyed because i can see the Hb dropping and nothing is being done about it. The Consultant allows a top up of blood to level out the desired Hb which they would like the boys to maintain at. So, if pre-transfusion Hb was below 9 consecutively then they could have a top up unit of blood. How would this one unit help when each transfusion their was a shortfall of blood given to them...each transfusion! I'm also annoyed because even though the older thals are tired pre-transfusion...they stay with the same policy and do not ask questions. All older thals are put into 'One Glove Fits All' type of treatment plan.

Please, please help me to understand. Am i worrying unnecessarily.   

Emby,

At the US centers, they are trying to keep patients above 10 if possible. It provides a better quality of life and also helps avoid complications like extramedullary hematopoiesis, where red blood cell masses grow outside the bone marrow, often posing danger to the spine or organs.
This is from the TIF Standards

The recommended treatment for thalassaemia major involves lifelong regular blood
transfusions, usually administered every two to five weeks, to maintain the pre-transfusion
haemoglobin level above 9-10.5 g/dl.

Pre not post. It seems many centers are happy with being above 9-10 post transfusion and this is no longer considered adequate.

Emby,

if your boys are getting less blood during each transfusion, can you reduce the current Tx interval? May be that will help to raise the Hgb to above 9.....here we reduce the frequency between 2 Txs from every 4 weeks to every 3 weeks if our daughter gets less blood due to getting smaller units in two consecutive Txs. Just a thought.

But I agree, it is very frustrating when you see that the child's HgB is low and they need more blood but you can't get more blood. 

Bostonian,

They did have their transfusion at 3 weeks instead of 4 weeks this time but still, although they are written up for a certain number of units, they were still given less than they needed. The consultant wanted 3 weekly transfusion ideally for all TM patients but even at three weeks, they still fell short of what they needed.

Andy, it is the same here too. their aim is to have the brother's Hb level to be between those levels, pre transfusion. How this can be maintained when there is shortfall of blood each transfusion...