Pre-transfusion hb 9 or 10

Hi everyone
What is an ideal pre-transfusion hb for a thal major? My pediatrician suggests an hb of 9 while the hemetologist said it is best at 10. For the past few months he has been tranfusing every four weeks and his pre transfusion has climbed from 5gm/dl to 8.1gm/dl. Our pediatrician has asked us to check his hb before we come the next time as she doesn`t want to transfuse if he is around 10.
maha

Hi,

I think it depends on the quantity and gap between transfusion period that the doctor selects.

I used to get 2 bags with a gap of 1 month when I was in KSA; They didn't Transfuse if the Hb was 10 or above.

Now here in Pakistan; at JSF I get 1 bag with a shorter gap (10-12 days as I've grown up) and they will transfuse at 10g/dl or above. Their stopping limit is 11g/dl

I think keeping Hb levels above 10g/dl all the time with less blood given frequently will ensure good health and less iron overload.

i think it should be around 9.5 to 10, not lower then that,i think it keeps child's bones in good shape,not letting bone deformation occur,and let child live a quality life.

ZAINI.

10.5 is considered to be the ideal Hb level to maintain. Below this, bone marrow activity increases rapidly. Even at 9, the bone marrow is about 2-3 times more active than normal. This means more potential for bone expansion and also more bad red blood cells for the spleen and other organs to filter out. It also means more chance for growth of extramedullary hematopoiesis, which are commonly found in conditions of chronically low hemoglobin levels. So, if at all possible, keep the Hb up.

Hi Sajid
You cannot go by the number of bags in KSA. This is the first time Hassan received 200ml, but the bags are always of varying quantity, sometimes it is 210cc, sometimes 260cc and this time it was 350cc. What a waste of blood ???My pediatrician suggests 12ml/kg every three weeks but we are comfortable with 15ml/kg every four weeks because his veins are very difficult to find. She is always open to suggestions so lets see what she says for a pre-transfusion hb of 10.5. First I will have to convince my husband though.
thankyou
maha

Vey informative post by Andy re. bone marrow activity, I did not knew that and now we know that why the level of 9 is unacceptable.

My daughter is transfused every five weeks, if the pre-transfusion comes 10 or above 10 she will be asked to come back in five weeks but if the level is below 10 than the time is only four weeks (NO EXCEPTIONS).

I would like to ask another question here. What if the child falls sick a day or so before the transfusion? This was the case with Hassan a couple of months back. My doc said she could not transfuse Hassan if he has fever. He had no apparent infection, but she still gave him antibiotics as all of us had throat infection and were on medications. The fever subsided in a day, but she booked us for transfusion only after he had completed the whole course of antibiotics. Is this the usual procedure or was she just playing safe.
regards
maha

Normally I bring Kinny ( my daughter ) for transfusion 4 weeks once which is about hb 9+ the doctor here (malaysia) advise that rate. After seeing all the post i think i will go for 10.5 which means i will make my coming appointment earlier for coming round. In Malaysia above hb 11 they don't accept for transfusion. Thank you for the info!!!

We are also learning that low hg, in addition to causing bone marrow expansion and extramedullary hemopoesis (causing the spleen to enlarge) in triggering bone marrow activity it also can cause damage to heart and lung tissue.  Also, it puts patients at risk of pulmonary hypertension.

In simple terms - when the hemoglobin is low - the body thinks that by producing a large blood volume it can make up for the low hemoglobin.  The bone marrow then expands - to increase its surface area - thinking that it can make more hg - this is what causes bone deformity and spleen enlargement. 

In doing this, the body ends up creating a very large volume of blood - this volume is too large for the arteries going between the heart and the lungs - this is one cause of pulmonary hypertension in thalassemia. 

Another thing that happens is that because the marrow is not suppressed at these low levels - some deformed cells are produced by the body, and also increased hemolysis occurs by the body causing fragments from these deformed cells to potentially cause clotting and shrinking of arteries (as these particles can narrow the arteries). 

In addition, the hemolysis that occurs as a result of this process can deplete the bodies supply of 'relaxers' such as nitric oxide which are important in relaxing the arteries to allow blood to flow through easier - therefore also contributing to pulmonary hypertension. 

These are some of the reasons that it is important to keep the hg up.  Good chelation and hg above 95 (in my opinion) is best. 

Sharmin

Very interesting discussion on on maintaining Hb levels. After much discussions, my dr has me on a step by step plan. 110 to 115 - 1 unit, below 110 - 2 units.

However, does anyone have the issue where you would symptomatically feel as though your pre-transfusion  level has dropped considerably and get the symptoms of low Hb, like the lower back pain, tired,  loss of appetite and so forth. But the pre-bt HB comes back and it's above 100. Leaves me in a surprise!!!!

Anyone else go through this too?

10.5 is considered to be the ideal Hb level to maintain. Below this, bone marrow activity increases rapidly. Even at 9, the bone marrow is about 2-3 times more active than normal. This means more potential for bone expansion and also more bad red blood cells for the spleen and other organs to filter out. It also means more chance for growth of extramedullary hematopoiesis, which are commonly found in conditions of chronically low hemoglobin levels. So, if at all possible, keep the Hb up.

In Seattle Children Hospital , Doc told us they ll keep hematocrit from 25-30 ( translates to around 9-10 Hb).
Generally the day before transfusion the Hb level are always around 9.  Its been tougher as my daughter weight is on borderline where she needs two bags or 1.

My 3 years old daughter take transfusion after every 5 weeks when hb level 9 or 8.8.

According to the above helpful informative discussion shall I transfuse her after 4 weeks ?

Last October her Ferritin was 1870.

Most thal specialists will tell you to never allow the Hb to drop below 9.5-10 if possible. It is needed to shut down the overactive bone marrow, which is responsible for many of the problems of thalassemia.

Thanks Andy..

We decided from next time our baby will take transfusion after every 4 weeks.

My daughter Aysel hemoglobin drops to 69, 74.
In Krasnoyarsk where we live we are in the hospital 5-7 days in the hospital , we have no conditions for blood transfusions and to be able to go home . just to be in the hospital 5-7 days and then blood transfusions of 300 ml at one time . first day order blood ,on the second day, pour 300 ml, the third day of the tests, the fourth day of the order a second time blood , the fifth day, pour 300 ml, the sixth day of the tests and can go home. the hemoglobin does not rise above 105-110 .