Discussion Forums > Thalassemia Major

Slow rate transfusion and warm antibody

<< < (2/15) > >>

Andy Battaglia:
Sharmin,

I wish there was something definite I could tell you, but with antibody reactions, it is often the case that there is no easy answer. Different tactics are tried and maybe a combination of tactics may work. Taking less blood at a slower rate is one. Prednisone is another. I have read that sometimes EPO is used along with prednisone but with mixed results. Although this is troubling, it can't be considered severe hemolysis, as his transfusion frequency is still measured in weeks. In cases of severe hemolysis, the initial dose of prednisone can be 100-200 mg.

http://www.merck.com/mmpe/sec11/ch131/ch131b.html


--- Quote ---Corticosteroids (eg,  prednisone Some Trade Names
DELTASONE
Click for Drug Monograph
1 mg/kg po bid) are the treatment of choice in warm antibody idiopathic AIHA. In very severe hemolysis, an initial loading dose of 100 to 200 mg is recommended. Most patients have an excellent response, which in about 1⁄3 is sustained after 12 to 20 wk of therapy. When stable RBC values are achieved, corticosteroids are tapered slowly.
--- End quote ---

I have mentioned this before and wonder if it is practical to find donors who are better phenotype matches. Donors with a similar ethnic background may help minimize the compatibility problem.

http://www.ncbi.nlm.nih.gov/pubmed/11071629


--- Quote ---The effect of red blood cell (RBC) phenotypic differences between donors (mostly white) and Asian recipients on the frequency of alloimmunization was determined. Additional transfusion and patient immune factors were examined. 14 (22%) of 64 patients (75% Asian) became alloimmunized. A mismatched RBC phenotype between the white population, comprising the majority of the donor pool, and that of the Asian recipients, was found for K, c, S, and Fyb antigens, which accounts for 38% of the alloantibodies among Asian patients...Transfusion of phenotypically matched blood for the Rh and Kell (leukodepleted in 92%) systems compared to blood phenotypically matched for the standard ABO-D system (leukodepleted in 60%) proved to be effective in preventing alloimmunization (2.8% vs 33%; P =.0005). Alloimmunization and autoimmunization are common, serious complications in Asian thalassemia patients, who are affected by donor-recipient RBC antigen mismatch and immunological factors.
--- End quote ---

http://www.blackwell-synergy.com/doi/abs/10.1046/j.0041-1132.2003.00589.x


--- Quote ---RBC autoimmunization and the development of autoimmune hemolytic anemia should be recognized as a complication of allogeneic blood transfusion. The need for additional blood transfusion was successfully avoided in one patient by treatment with recombinant human EPO and corticosteroid therapy. Once RBC autoimmunization is identified, subsequent management should incorporate a strategy that minimizes subsequent exposure to allogeneic blood.
--- End quote ---

http://bloodjournal.hematologylibrary.org/cgi/content/full/97/12/3999


--- Quote ---Previous data on a presumed homogenous population in Greece and Italy also showed an overall low rate (5% to 10%) of alloimmunization.2-3 The difference between our experience of lower rate of alloimmunization (7.4%) and Singer et al's higher rate (22%) can be explained by our access to phenotypically matched donors in Hong Kong. We agree with Singer et al's recommendation that the recruitment of Asian blood donors in North America, just like the recruitment of black donors for sickle cell disease patients, can increase the availability of compatible blood for thalassemia patients, who have a lifelong need for transfusions.
--- End quote ---

If there is a large enough Asian community in your area, it may be practical to arrange for blood from a similar population. It may require some work to find a group of matching donors or it may be possible through the blood bank. It is something you should talk to the doctor about. I would also suggest that if it is at all possible, you consult with Dr Vichinsky about this. I don't know if a phone consultation would be possible, but it would seem sufficient as an examination of your son shouldn't be necessary. Dr Vichinsky has much experience with this and may be able to advise a strategy to deal with it before it does become worse.

Sharmin:
Thank you Andy.  We plan to see Dr. Vichinsky in the fall - I wonder if perhaps we should go sooner. 
After his nap - he bounced out of bed and seems well.  His color also looked a little better. 

The highest dose of prednisone he has been on is 40mg - for 7 days.  It was then tapered to 20 (4 days), 10 (4 days) and now we are on 10mg every second day as usual.  His rate of transfusion was decreased from 90cc/hr to 80cc/hr - but he was given both units.  Next time perhaps we can slow the rate further and take only half the amount - and go in two weeks later for the other half.  I think this may be best in the long run.

My son's blood type is O - and he has 7 allo antibodies so it is really difficult to find a donor for him.  The hospital takes 4 large vials of blood to cross match him. 

We will make an appointment to see Dr. Vichinsky as soon as possible - thanks again Andy. 

We'll do his blood test Thursday morning - if his hg is still in the 90s (it will be almost 4 weeks) then things are good.  I'll keep you posted.

Thank you for all of the information - I will share it with our doctor.
S

Sharmin:
Andy,

My son's hg today is 80 - 3 weeks post transfusion.  I am really confused because 1 week ago it was 122.  He looked great until last Friday - very red - but he woke up looking pale Saturday morning.  I know that most of the hemoloysis happened over night.  I am not sure what would have caused the sudden drop.   I was hoping that he would be at least 90 because of the high dose of prednisone he was on.  I am hoping that we can begin transfusing him at a slow rate every two weeks, because I notice that it is between the 2nd and 3rd week that he drops drastically.  I wonder if transfusing him 15cc/kilo rather than the 20cc/kilo he is getting now - every two weeks may be best.  I know that the transfusion requirement is not out of control right now, but the problem is getting worse rather than better. 

I am very afraid right now, and we are looking into seeing dr. vichinsky next month. 

Thanks again,
Sharmin

Manal:
Sharmin, i am praying for you and for your son. I am sure that things will be much better, please update us :hugfriend
manal

Sharmin:
Manal,

Thank you so much for your support.  The hospital called saying that they will need more time to find matching blood for him - I hope that they find it soon, before the antibody reduces his hg further.  Our pediatrician says that Andy's suggestion makes a lot of sense and wants to follow the plan that we suggested to him.  It has been a stressful day waiting around for the blood, but my son is running around playing so that makes me feel better.  His eyes are bright and he looks very happy.  We have to be thankful for every positive moment we get:)  Thank you for your prayers Manal, I pray that all of our children are healthy soon.   :hugfriend

Navigation

[0] Message Index

[#] Next page

[*] Previous page