BLOOD TRANSFUSIONS

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What is a blood transfusion?

A blood transfusion is a common procedure in which you are given blood that has been donated by another person. A transfusion is sometimes needed to manage complications of sickle cell disease.

Goals of transfusion:

  1. Increase total blood count (hemoglobin).

  2. Lower the number of red blood cells that contain the S (or sickle) protein.

 

3 types of transfusions:

 
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SIMPLE TRANSFUSIONS

Donated blood is given through a vein to increase your hemoglobin.

 
 
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MODIFIED EXCHANGE

Sometimes your hemoglobin is high, and getting more blood could cause other problems. In this case, some of your own blood may be removed through a vein. Donated blood is given to replace the blood that was taken.

 
 
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RED CELL EXCHANGE

Sometimes it is better to replace most of a person’s red blood cells with donated blood. In this case, your blood is removed through a vein and goes through a machine where red blood cells are removed at the same time donated blood is given back to you to replace what is taken.

 
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Transfusion safety

  • Donated blood is tested to make sure diseases are not passed on to the person who gets the blood.

  • The blood that you get is matched to your blood type (O, A, B, or AB) and to your own special blood proteins (antigens).

  • People with sickle cell disease have to be careful that the hemoglobin does not get too high after a transfusion. A hemoglobin that is too high could cause the blood to be thick and increase the chances of having a stroke.

  • If you get a lot of transfusions, too much iron can build up in your body. If this happens, you will need to take medicine (called iron chelation therapy) to get rid of it.

 
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When is a blood transfusion needed? it might be needed if:

  • You have acute chest syndrome

  • You have a stroke

  • You have priapism

  • You have an enlarged spleen

  • You are very sick

  • Your current hemoglobin is much lower than your usual level and you are having trouble breathing, are feeling tired, or are light-headed.

  • You are having surgery with general anesthesia (medicine to put you to sleep for surgery) and the surgery will take longer than 30 minutes.

When is a blood transfusion not needed? It is not needed if:

  • Your hemoglobin is not lower than your usual level, even when you have pain.

  • It could make your hemoglobin level too high (above 10 g/dL).

  • Knowing what your blood count (hemoglobin level) is when you are not sick can help you and your provider decide if you need a blood transfusion when you do get sick.

Blood reaction

Your body may react to the blood you get during a transfusion:

  • You may have an allergic reaction that causes itching and hives while you are getting the blood, and a fever and/or chills soon after.

  • Your immune system may see the blood as something foreign and try to destroy the new red blood cells.

  • You may feel sick to your stomach.

  • You may have have back pain.

 
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Getting blood transfusions on a regular basis

  • Getting blood transfusions on a regular basis can be used to prevent or treat some types of problems caused by sickle cell disease.

  • Your provider will follow a set of guidelines for giving blood transfusions on a regular basis. These guidelines tell what conditions can be treated or prevented with transfusions. They also help your provider decide what your hemoglobin and hemoglobin S should be between transfusions.

  • These numbers are what your provider will use to figure out how often you need to get a transfusion. The hemoglobin S goal is usually between 30% and 50% depending on why you are getting regular blood transfusions.


    Iron build-up

  • If you get a lot of blood transfusions, too much iron can build up in your body, so have the iron levels in your blood tested regularly. An MRI (magnetic resonance imaging) of the liver can tell how much iron is collecting in your liver. This test is usually done every 1-2 years, but will depend on your specific needs.

  • If your body is high in iron, you will need to take medicine (called iron chelation therapy) to get rid of it.

 
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Blood transfusion checklist

For you and your health care provider

 

Special proteins:

🄯 Talk with your provider about getting blood that has been specifically tested for these special proteins: C, E and Kell.

Hemoglobin:

🄯 If your usual hemoglobin is around 10 g/dL or more, talk about the type of transfusion that may help but will not raise your hemoglobin too high.

🄯 If your hemoglobin is lower than normal or if you have pain or yellowing skin or eyes (sometimes called jaundice) within a few weeks after getting a transfusion, you may be having a delayed reaction to the blood.
🄯 Talk with your health care provider about when a blood transfusion might be needed and what type of transfusion you should get.

Iron chelation therapy:

🄯 If you get a lot of blood transfusions, too much iron can build up in your body. You should have the iron levels in your blood tested regularly.

🄯 An MRI (magnetic resonance imaging) of the liver can tell how much iron is collecting in your liver. This test is usually done every 1-2 years, but will depend on your specific needs.

🄯 Talk with your hematologist about being on iron chelation therapy.

If you do take iron chelation medicine:

🄯 Have your eyes checked by an ophthalmologist (a special eye care provider) every 1-2 years to screen for eye damage from the medicine.

🄯 Have your hearing checked every 1-2 years to look for hearing loss caused by the medicine.

🄯 Talk with your health care provider about checking your kidney function on a regular basis.

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SECTION OVERVIEW

  • Donated blood needs special testing to get the best match for you.

  • You may need a blood transfusion for some problems caused by sickle cell disease.

  • Talk with your provider BEFORE you get sick, and make a plan (when a transfusion might be needed and what type of transfusion) for blood transfusions in case one is needed in the future.

  • Getting blood transfusions on a regular basis can treat or help prevent some problems caused by sickle cell disease.

  • The amount of iron in your body should be checked regularly and treated with iron chelation therapy if the iron level is high.

  • If you take iron chelation medicine, you should have your eyes, hearing, and kidneys checked on a regular basis to look for side effects.