Discussion Forums > Thalassemia Major

Pre-transfusion hb 9 or 10

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Canadian_Family:
Vey informative post by Andy re. bone marrow activity, I did not knew that and now we know that why the level of 9 is unacceptable.

My daughter is transfused every five weeks, if the pre-transfusion comes 10 or above 10 she will be asked to come back in five weeks but if the level is below 10 than the time is only four weeks (NO EXCEPTIONS).

maha:
I would like to ask another question here. What if the child falls sick a day or so before the transfusion? This was the case with Hassan a couple of months back. My doc said she could not transfuse Hassan if he has fever. He had no apparent infection, but she still gave him antibiotics as all of us had throat infection and were on medications. The fever subsided in a day, but she booked us for transfusion only after he had completed the whole course of antibiotics. Is this the usual procedure or was she just playing safe.
regards
maha

Kinny:
Normally I bring Kinny ( my daughter ) for transfusion 4 weeks once which is about hb 9+ the doctor here (malaysia) advise that rate. After seeing all the post i think i will go for 10.5 which means i will make my coming appointment earlier for coming round. In Malaysia above hb 11 they don't accept for transfusion. Thank you for the info!!!

Sharmin:
We are also learning that low hg, in addition to causing bone marrow expansion and extramedullary hemopoesis (causing the spleen to enlarge) in triggering bone marrow activity it also can cause damage to heart and lung tissue.  Also, it puts patients at risk of pulmonary hypertension.

In simple terms - when the hemoglobin is low - the body thinks that by producing a large blood volume it can make up for the low hemoglobin.  The bone marrow then expands - to increase its surface area - thinking that it can make more hg - this is what causes bone deformity and spleen enlargement. 

In doing this, the body ends up creating a very large volume of blood - this volume is too large for the arteries going between the heart and the lungs - this is one cause of pulmonary hypertension in thalassemia. 

Another thing that happens is that because the marrow is not suppressed at these low levels - some deformed cells are produced by the body, and also increased hemolysis occurs by the body causing fragments from these deformed cells to potentially cause clotting and shrinking of arteries (as these particles can narrow the arteries). 

In addition, the hemolysis that occurs as a result of this process can deplete the bodies supply of 'relaxers' such as nitric oxide which are important in relaxing the arteries to allow blood to flow through easier - therefore also contributing to pulmonary hypertension. 

These are some of the reasons that it is important to keep the hg up.  Good chelation and hg above 95 (in my opinion) is best. 

Sharmin

Khwahish:
Very interesting discussion on on maintaining Hb levels. After much discussions, my dr has me on a step by step plan. 110 to 115 - 1 unit, below 110 - 2 units.

However, does anyone have the issue where you would symptomatically feel as though your pre-transfusion  level has dropped considerably and get the symptoms of low Hb, like the lower back pain, tired,  loss of appetite and so forth. But the pre-bt HB comes back and it's above 100. Leaves me in a surprise!!!!

Anyone else go through this too????

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