Blood Transfusions

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  Filtered and Irradiated Blood
  Irradiation of Transfused Blood
  Transfusion Dependent & Complications
  Developing Antibodies after Transfusions
  Acceptable Platelet Counts
  Religious Objection to Blood Transfusion
  ATG Without Blood Transfusion?

Filtered and Irradiated Blood

Why is it important for aplastic anemia, MDS, and PNH patients to requests filtered and irradiated blood when receiving transfusions?

Screening out damaging leukocytes with leukocyte blood filters is essential to minimized adverse reactions following blood transfusions. Low-level radiation also reduces the amount of lymphocytes in blood, reducing the risk of transfusion-associated graft-versus-host disease. For optimum results, both processes should have been carried out on the blood for your transfusion, but you will need to check this at the time of ordering, and ask the nurse to check again at the bedside. In addition, try for blood that has been leukocyte-filtered before storage, rather than filtered at the bedside. The former is more efficiently filtered. There are no known negative side-effects to blood treated in these ways. A spokesperson at America's Blood Centers stated that insurance companies generally accept the need for these products when fighting aplastic anemia and MDS.

Irradiation of Transfused Blood

Does irradiation eliminate the formation of antibodies when you receive red blood cells?

No, irradiation does not eliminated the formation of antibodies against

red blood cells or

Cells in the body that fight disease and infection by attacking and killing germs. There are several types of white blood cells including neutrophils, eosinophils, basophils, lymphocytes and monocytes. Each type of cell fights a different kind of germ. Also called WBC, leukocyte.

white blood cells; it only prevents the blood donor's white blood cells from being able to multiply in the recipients blood and mount an immune response against the recipient.
In order to prevent formation of antibodies, which may eventually limit the response to transfused platelets, red cells and platelets should also be filtered, which removes white cells. This may also prevent immediate infusion reactions and decrease the chance of the recipient acquiring Cytomegalovirus (CMV), which is a widespread opportunistic virus that can cause disease in an immune suppressed person.

Transfusion Dependent & Complications

How long can a person have blood transfusions? What are the complications?

There is no limit to the time in which a patient can receive blood transfusions, even up to 20 years. However there are some complications which can arise.

Red blood cells transfusions contain iron that accumulates in the body and can damage normal tissues. The immune system is stimulated by exposure to proteins on the transfused blood cells and over time, the patient may produce antibodies that destroy the transfused red blood cells or platelets. Blood transfusions may contain viruses or other infections that may be passed to the recipient. However, the blood supply is safer now than ever due to development of test to detect the major infections which can be passed by transfusion, but there remains a risk of transfusion related infection.

Developing Antibodies after Transfusions

Are there any statistics on the development of antibodies by transfusion recipients? Are there an average number of units before the risk climbs to significant levels?

Some patients develop antibodies after only one transfusion while others never develop antibodies. 

Red blood cells antibodies occur in patients with rare blood types. These patients lack antigens, or markers, on the red blood cell surface.   White cell antibodies can occur because of differences in the HLA types between donors and recipients. This can cause problems for patients who need platelet transfusions, because the platelets carry the same HLA antigens.   A conservative approach is to use transfusions only when they are necessary.

Acceptable Platelet Counts

What is an acceptable platelet count for patients who are not having symptoms?

The numbers are not as important as the symptoms. If a patient is treated in a supportive fashion, most patients can tolerate extremely low

platelet counts as long as they are not bleeding. If bleeding occurs, Amicar can be tried. For patients who have had a major bleeding complication, the physician would tend to be more aggressive and transfuse when the platelet counts go below 10,000 even if there is not active bleeding at that point.

Religious Objection to Blood Transfusion

What other treatments are available for Jehovah's Witness patients who have a religious objection the use of blood transfusion?

Cyclosporine does not carry the risk of transiently causing low platelets (such as in anti-thymocyte globulin,

ATG is an immunosuppressant, a drug that lowers the body's immune response. Scientists believe that aplastic anemia happens when the immune system attacks and destroys bone marrow stem cells. ATG kills the specific cells that are attacking the bone marrow stem cells. This allows the bone marrow to grow and make new blood cells. ATG may be used to treat other bone marrow failure diseases in some cases. ATG is approved by the U.S. Food and Drug Administration (FDA) for treating moderate and severe aplastic anemia. ATG is commonly used with another drug called cyclosporine.

ATG) and could be tried. A few patients have been treated with colony-stimulating factors, such as

A man-made version of a naturally occurring substance in the body (erythropoietin) that encourages the bone marrow to make more red blood cells. Epoetin alfa can help improve red blood cell counts in bone marrow failure disease patients whose natural erythropoietin levels are low. It is given by injection under the skin (subcutaneous) or in the vein (intravenous). Epoetin alfa is approved by the U.S. Food and Drug Administration (FDA) for treating anemia. It is in a class of drugs called growth factors (cytokines).

erythropoietin (Procrit, Epogen) or granulocyte colony stimulating factors (G-CSF, Filgrastim). These may increase the white counts and

(NOO-truh-fil) The most numerous of the white blood cells, important for helping the body fight infections (particularly bacterial and fungal infections.

neutrophils but would not be expected to cure the patient or to change the risk of dying from severe complication.

ATG Without Blood Transfusion?

What are the success rates of ATG therapy without blood transfusion support for aplastic anemia patients?

At the moment there is no substitute for the transfusion of blood and of certain blood products. With respect to the use of these agents in the course of

ATG (anti-thymocyte globulin) treatment, it will depend to some extent on the blood count before starting ATG.

(throm-buh-sie-tuh-PEE-nee-uh) A condition in which there is a shortage of platelets in the bloodstream. This results in a low platelet count. Bleeding and bruising often occur with thrombocytopenia.

Thrombocytopenia is a serious problem which may be made transiently worse during a course of ATG: therefore

The smallest type of blood cell. Platelets help the blood to clot and stop bleeding. Also called a thrombocyte.

platelet transfusions are given almost in every case to patients with aplastic anemia or PNH who receive ATG treatment.