Discussion Forums > Thalassemia Major
can someone help me out?
Sharmin:
Thank you Zaini, Manal and Andy :hugfriend
I actually have good news - my son was transfused last Tuesday - and the doctor did a post transfusion hg which was 118 (because he was very low to begin with).
He had us do another one today because he wanted to see if the large drop last week was due to the fever and illness or if it was because of the antibody going crazy again. The blood test today revealed that his hg is 117! So his transfusion tomorrow will probably be postponed.
Even if there was a degree of error - in the post transfusion hg or this one - there does not appear to be a lot of antibody activity going on! I hope that things continue to go well. Look my friends, your prayers were heard over night! I'll keep you all posted - when we we check again next week.
Sharmin
Andy Battaglia:
Sharmin,
That is a big relief! If his Hb has maintained at the same level for a week after transfusion, slowing down the transfusion rate may not be needed. The effect of slowing the blood is to decrease the immediate breakdown of RBC's that can occur on autoimmune hemolytic anemia. This also has me thinking that his drop in Hb may not be related to the AIHA and more likely just a result of illness.
Sharmin:
Thank you Andy, it has been a great relief. We will be testing his hg on Sunday and transfusing him on Monday. I am glad that things are going well so far. He does tend to drop rather quickly nearing the end of his 3 weeks - I am wondering whether it may be a good idea to spit his transfusion up so that he receives a unit every two weeks - using a slower rate - rather than getting the entire amount every 3 weeks. It may maintain him better and he may be getting less blood over time.
Andy Battaglia:
Hi Manal,
The answer about folic acid is in the same article at http://www.emedicine.com/med/topic979.htm
--- Quote ---Administer folic acid because active hemolysis may consume folate and cause megaloblastosis (abnormally large nucleated red blood cells).
--- End quote ---
Almost all thal majors are deficient in folate because the excessive hemolysis needs more than is being supplied. This increases with the hemolysis, and increases the need for folic acid. One other thing I want to note is that I keeping seeing mention of masked vitamin B-12 deficiency in thals. B complex should really be considered to help counter the daily physical stresses of thalassemia.
Sharmin,
I have always wondered about this issue since some thals transfuse monthly and others twice monthly. Since the transfused blood begins to break down so quickly, it does seem that twice monthly would be more efficient and patients wouldn't tire so much when it's close to their transfusion date. Talk to your doctor and see what he says. I think one reason some take blood only once monthly is for time considerations; accommodating school or work schedules, etc.
Sharmin:
Andy,
you are right, it would be easier on thals to transfuse twice a month. I wonder if it is to avoid exposing the patient to fewer donors over time - 12 a year rather than 24.
I know of some thals who transfuse biweekly - because it fits in with their work schedules better than taking a day off of work each month. I think I may prefer this for my son - it should work especially well in his situation.
Sharmin
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