Hives

Our little girl (2 and 1/2) has just had her second transfusion.  The first time she reacted as we were leaving the hospital with a quick, intense breakout in hives.  She was given benadryl and they went away within the hour.  The doctors feel she was allergic to whatever they suspend the blood in.  She continued to break out for about 9 days afterwards.  Hives came up, didn't bother her too much, and the places varied.  Sometimes they went away on their own, other times I had to give her benadryl.  They told us it is highly unlikely for her to be reacting to the transfusion and she may have picked up a virus.

This second time they gave her benadryl prior to the transfusion.  She did alright, but has once again been breaking out for the past week in hives the same way. 

Has anyone else had this type of reaction? 

Dear ocwoodmanp,

You daughter could be reacting to something in the hospital such as the linens if not the blood itself.  Perhaps you can try to give her something like Reactin (please consult your doctor first) for a few days before her next transfusion.  The reaction could be related to blood as well.  Has she had genotype testing done to ensure that her blood is as compatible as possible?  I highly recommend this test.

Does your daughter have any other allergies?

Sharmin

Are you getting washed, packed cells?

If the blood is not being washed before transfusion, then the reaction could be due to this reason. You may want to try with an "avil" injection in the blood stream, immediately after starting transfusion.

I have seen that help a lot of people who used to get hives and/or fever due to a reaction.

Poirot

Thank you Sharmin and Poirot. 

Our little girl seems to only have allergies to fresh strawberries and whatever this is that is going on.  The benadryl is taking care of it, but benadryl seems to intensify her moods (for lack of a better way to say it) so I hate to keep giving it to her.  It does take the hives away though.  I was wondering if something else would take the hives away and she would not react quite as much. 

I do not know if she has been genotyping.  When they put her pic line in they do test the blood they said for type and something else (I can't remember right now).  I do believe the blood is washed - but not positive.  I am wondering about the antibodies, although the on-call doctor didn't think it was that or she would have reacted faster the first time.

I am just confused, but thank you so much.  I have my list of questions now for the hospital.  I will mention the reactin and avil to the doctor and see what she says.

I can't thank you enough!

Sharmin
Just wondering - when our daughter was being tested for thal they did a complete blood panel.  They redid the panel last Spring.  I was just wondering if that would most likely include the genotype testing?  They wanted it redone as they felt our daughter would soon need transfusions.

Ocwoodmanp,

When my son was first diagnosed 10 years ago they did not do a genotype test on him (a test that needs to be done once, it is a test that looks at the dna of the patient to determine what antigens he/she will react to and which ones the patience has so that they do not need to be avoided in the donor pool).  Genotype testing is the most sophisticated testing that can be done in order to ensure that a very close match is found for transfusion and antigens that are likely to cause trouble are avoided. 

What you describe is a crossmatch which is done before each transfusion - in this procedure the patient's blood is testing to see what it is reacts with and then an appropriate donor is found.  Having genotype matching makes this procedure accurate. 

Reactin causes less drowsiness and moodiness than Benadryl.  Benadyl acts quicker in case of a severe reaction.  For long term use I would suggest the use of Reactin, which you can begin giving a few days before transfusion and continue for a few days after.  You should consult with your child's doctor before giving any of these.  Hopefully over time your daughter will react less to transfusions.  But since your daughter has a tendency to react I suggest that you should have the genotype testing done soon.  You can speak to your doctor who can have the blood bank send the sample to a lab where they can do the test and have the results back to your blood bank within a few weeks. 

The blood panel is a blood test with a complete blood count and is not the same as a genotype test.  It simply measures RBC, WBC, platelets etc (if I am correct, Andy?). 

Sharmin

CBC does not include antibody testing.

As far as hives, they are somewhat common and many patients routinely take benadryl before the transfusion starts.

http://www.merck.com/mmpe/print/sec11/ch146/ch146e.html

Allergic reactions

Allergic reactions to an unknown component in donor blood are common, usually due to allergens in donor plasma or, less often, to antibodies from an allergic donor. These reactions are usually mild, with urticaria, edema, occasional dizziness, and headache during or immediately after the transfusion. Simultaneous fever is common. Less frequently, dyspnea, wheezing, and incontinence may occur, indicating a generalized spasm of smooth muscle. Rarely, anaphylaxis occurs, particularly in IgA-deficient recipients.

In a patient with a history of allergies or an allergic transfusion reaction, an antihistamine may be given prophylactically just before or at the beginning of the transfusion (eg, diphenhydramine 50 mg po or IV). Note: Drugs must never be mixed with the blood. If an allergic reaction occurs, the transfusion is stopped. An antihistamine (eg, diphenhydramine 50 mg IV) usually controls mild urticaria and itching, and transfusion may be resumed. However, a moderate allergic reaction (generalized urticaria or mild bronchospasm) requires hydrocortisone (100 to 200 mg IV), and a severe anaphylactic reaction requires additional treatment with epinephrine 0.5 mL of 1:1000 solution sc and 0.9% saline IV (see Allergic and Other Hypersensitivity Disorders: Treatment) along with investigation by the blood bank. Further transfusion should not occur until the investigation is completed. Patients with severe IgA deficiency require transfusion of washed RBCs, washed platelets, and plasma from an IgA-deficient donor.

Hello,

This happened to me a lot of years ago (about 18-20) so I started taking an antihistamine. In Spain is called Polaramine (I don't know the scientific name) and I have it before the transfusion. Since then, this episode has not been repeated any more. The only thing is that it makes me be a little bit sleepy but the effects only last for about 2 or 3 hours.

Best regards,

Laura.

Thank you so much!  It has been really strange.  Sometimes they go away on their own, other times they are so bad and itchy she needs benadryl.  Each day she has had some go away and others need medication for. 

It has been 9 days and she just stopped breaking out.  They told us to try her on the zyrtec the day prior to the transfusion and they will pre-med her on transfusion day.  She may need to be given the zyrtec they said for a number of days afterwards until and if this cycle stops.  I have not used zyrtec on her and wonder how she will react to that.  I am looking into the other meds you all mentioned and will consult with them the next time we go at the end of January.

Thank you so much!!!!!!

I use Zyrtec with my daughter for nose allergy, it is a mild medicine. Usually it is one dose daily and i give it before sleeping. Since she sometimes takes it for two or three weeks continously, she got used to it and doen not feel sleepy at all

hope this helps

manal

i have been having hives almost everday and it not because of transfusion

Sorry, what are hives? My dictionary dont know them  .

Dore,

       

Its kind of a skin rash.

http://en.wikipedia.org/wiki/Urticaria

Zaini.

Jakkes, I am glad I have never had them. Though It looks like the skin rashes I had from desferal. Are this itching hives? I hope they will disappear by the others.

Our daughter is still breaking out after each transfusion.  The last time they had us give her zyrtec for 4 days.  When we completed the zyrtect on Friday she was fine Saturday and then Sunday night she broke out again.  It lasts 9 days (as always).  They do give her benadryl about 20 minutes before the transfusion. 

Due to the continuation of the problem (and the fact that is lasting exactly 9 days after a transfusion each time) we now have to take her to an allergy and immunology specialist in March. 

I am not as concerned about the rashes as she does alright sometimes and not others.  I am, however, concerned about giving her so much medication each month.  Anyway, we shall see.

Thanks so much for all the information.

Andy,
I do have a quick questions.  When our daughter was first diagnosed by her pediatrician, they did all kinds of tests on the molecular level to make sure she was indeed thal major.  They did an entire panel.  One year later (as they felt she was getting close to transfusions) they did another complete panel.  I didn't think about that until now - does this usually include the genotype testing?