Discussion Forums > Thalassemia Major
Advantages of using a filter during transfusion
Sharmin:
The filter can also minimize antigens from entering the body, therefore reducing the liklihood of developing anibodies against various types of blood - if children begin developing many antibodies it limits the donors who can donate blood to that child. And as Sajid and Zaini have mentioned it reduces the other contents of the blood, which your child does not require, from entering the body. I am sure that Andy can expand on this, I really believe that a filter is important during blood transfusions. Know however, that some antigen's may cross the filter and your child may still produce antibodies - but you are reducing the chances of this with a filter, and possibly introducing fewer varieties of antigens to your child.
Sharmin
Andy Battaglia:
Filters filter out the white blood cells (leukocytes). Removing the white cells removes much of the antibodies present in the blood. These antibodies can cause reactions and are a main cause of post-transfusion fever. If at all possible, filtered blood should always be used.
There are two very good sites that discuss this subject.
http://www.scbcinfo.org/publications/bulletin_v1_n2.htm
--- Quote ---Preventing or delaying alloimmunization to leukocyte antigens in selected patients who are chronic transfusion candidates. Platelet survival is frequently diminished in patients who require repeated transfusions. This is most commonly due to antibodies directed against HLA Class I antigens expressed both on white cells and platelets. There is evidence that it is the leukocytes in platelet concentrates, rather than the platelets, which induce the formation of HLA antibodies. Rates of platelet alloimmunization can be reduced if the white cell content of red cells or platelets is less than 5.0 x 106/unit. Leukodepletion of this order can be achieved with most of the third generation filters, and also with newer apheresis platelet collection procedures.
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http://www.emedicine.com/med/topic107.htm
--- Quote ---Deterrence/Prevention
* Delayed hemolytic transfusion reactions
*
o Properly identify the serology of alloantibodies prior to transfusion, and properly identify antigen-negative RBCs if alloantibodies are present.
o Patients with alloantibodies require fully crossmatched (ie, anti-immunoglobulin phase) donor units.
o In ethnic minorities who have received multiple transfusions, testing patients for commonly involved antigens (eg, Rh, Kell, Kidd, Duffy) and using antigen-negative units can significantly reduce the frequency of alloimmunization. However, the cost effectiveness of this approach must be considered because most patients who have received multiple transfusions do not form clinically significant alloantibodies. A more cost-effective approach is to match the ethnic origin of donors and recipients, reserving extensive antigen typing for recipients who have been previously alloimmunized. These patients may also benefit from leukodepleted RBCs because leukoreduction appears to decrease the frequency of alloimmunization to RBC antigens, possibly due to decreased stimulation of TH2 lymphocytes associated with transfusions.
o If attempting to transfuse Rh-positive units (RBCs, platelets, or granulocytes) into an Rh-negative recipient, prevent alloimmunization to the D antigen by administering intravenous Rh-immunoglobulin (eg, WinRho SD, 10-12 mcg/mL of transfused Rh-positive RBCs). If transfusing a large number of Rh-positive units, reduce the dose of Rh-immunoglobulin after removing the antigen load by RBC exchange.
* Refractoriness to platelet transfusions
*
o Primary alloimmunization to class I HLA antigens present on platelets involves active donor APCs.
o Removing leukocytes by filtration or buffy coat removal or deactivating APCs by ultraviolet-B irradiation reduces the frequency of alloimmunization.
o Leukocyte reduction is indicated in all patients who are expected to be transfused repeatedly, especially candidates for bone marrow transplantation. These patients may also benefit from initial HLA typing and transfusions from crossmatched or HLA-matched platelets.
--- End quote ---
mrtariqkhan:
Hi,
Thanks everyone for the replies these are of great help....
Zaini- Thanks for the detailed reply iam sad for your daughter, our daughter too was diagnosed with intermedia but she dropped below 6 so we had to transfuse her at 6 months. Now she is totally dependent on the transfusions... best of luck with your daughter. I well definetly let know my wife of your generous advices. thanks a zillion....
Sajid- Yes my wife told me about you and mum. My wife was very happy to see you doing so good. she was very impressed.... well the blood transfusion went quite tiresome for us as they gave us in the last. and viens of such a small kid is always very difficult to get... nurses at pims are quite trained in this regard but the blood quality there is not good.... anyhow i hope this process will get easier in future i mean when huda will get older... keep up the good work. btw i am a web developer and have a experince of 2 years plus now. if i can be of any assistance in the site please let me know....
Andy - Thanks for the conclusive reply to my question i have posted another one would you be kind enough to answer that too....
Again everyone thanks for the welcome and replies.. I appreciate everything...
Andy Battaglia:
Yes, the reason for the yellow color and high bilirubin is the excess hemolysis or break down of the transfused red cells. This happens because antibodies in the blood react to the antigens in the donor blood. These antibodies are increased in the blood due to previous transfusions. The more one is transfused, the more one accumulates these antibodies. This is why using a filter or filtered blood is so important. Removing the white cells and the antibodies contained in them is very important in improving the survival of the transfused red cells and also avoiding transfusion reactions. As you suggested, accurate cross matching is also a very important factor in avoiding excessive hemolysis.
If at all possible, use a filter during transfusion. One other thing that may help is using prednisone along with the transfusions. This can help counteract the immediate antibody reaction and lead to longer life for the transfused red cells. Perhaps Sharmin can share her experiences with her son regarding this.
mumtaz:
A-o-A Mr Tariq.
i am agreed with Mr Sajjid and Zaini. i am Mumtaz, my son also having the problem that he always got reaction at the time of transfeusion, so the doctor advise us to use blood after wash, method is, they saparate RBCs from WBCs, and then they washe RBCs by normal Sciline( in our lanugage Glocouse), to remove remainig WBCs from RBCs. Allhumduallah my son is now not frequiently reacted by the blood. so u should talk with ur doctor before adopting this method.
May Allah solve our Problems
Allah Hafiz
Mumtaz
--- Quote from: mrtariqkhan on June 20, 2007, 10:23:22 AM ---Hi!
I have recently started reading on the net for my daughter who is a thal major and found this forum pretty useful i have to say people like andy and sajid are doing an awesome job keep it up :hugfriend.
Can someone tell me the advantages of using a filter during transfusion and also one of the doctors said that it will lower the amount of iron that goes in due to transfusion (is it true) . In Pakistan it costs around $40, could someone please guide me that spending this amount is really necessary each time.
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