Discussion Forums > Thalassemia Major

Transfusion problems

(1/3) > >>

maha:
Hassan now weighs 16.8 kg and is transfused with 250cc packed cells. Since he gets transfused in a private hospital we have to arrange for the donor as they usually do not have fresh blood. This time the blood bag had 285cc blood and Hassan needed 250cc. Each time 50cc is filled in a syringe and is transfused mechanically @ of 66cc/hour. When the syringe was to be filled the fourth time the nurse could draw only 40cc as the blood bag was empty and the blood was not coming out of the filter. There was around 15 - 20 cc blood in the tubing and he was given everything. So instead of getting 250cc he could get only 210cc.
When we contacted the lab they informed us that only 10cc could get lost in the filter. We asked the lab superviser to come and check the unit and when we questioned him he said the filter probably had 40-50cc blood trapped. Then what happened to the rest of the blood.This was the sixth time he had received 250cc and the earlier transfusions had gone fine. Usually the bag has over 350cc and this was the first time the bag weighed 285cc. According to him only 260- 295 RBC`s can be obtained from a single donor(450cc) and to avoid such problems we should bring in two donors. When I told him the blood bag weighed 392cc during Hassan`s last transfusion, he said it was because of the anticoagulant added to it. Now what does he mean by that ?does Hassan receive only 200cc of packed RBC`s and 50cc anticoagulant. I have been trying to verify what he has said but haven`t had any luck so far. I would really appreciate every little info you all could give about RBC`s as I want to go for the next transfusion armed with answers.

maha

Waleed:
maha. well i guess making all those things calculated is NOT EASY. because of the fact that evrytime you will never get same amount of RBC's it depend from person to person. If u get that bag of 300cc then u r very lucky ... we normally get 250ml and that is really OK... ideal to raise hb in this formula ...   ml of RBC  / (3x bodyweight in kgs)  . I remember in pakistan especially during summer an whole blood bag of 420ml would yield only around 100cc sumthin and we had to laugh at the bag. No body can do anything in it. but if u get atleast one bag of 250 ml then you shud b satisfied ... and having said that ..there's always leftover blood thats wasted in the blood tube and filter ... no matter in wut quantity the blood is trapped in it what i experienced thru all my life is still 250ml bag wud raise my hb by 2 according to the above formula ... and if anticoagulant is added in 250RBC and makes it 310ml IT DOES NOT MEAN of 310ml of RBC it still mean250 ml. you should not worry about those 20-30 cc trapped. its all that we face and not a big deal i think. cuz if u'll arrange another donor for mere 40-50 cc u'll b wasting the rest of the blood which i think nobody would like as that blood cud hav saved another life ... Just cheers

maha:
Hi Waleed
Here the blood volume is calculated at 15ml/kg. When you require 250cc and you get 210cc will it not affect his hb. This time around we have decided to take him in three weeks time instead of four weeks as he got only 12.5ml/kg.You had mentioned that you have never used a WBC filter to date but there are many who use one. So if one unit is 250cc and a filter is used, only 160-170cc is transfused, the rest is trapped in the filter. Is it? I just want to know this so as I can know if the lab has made any mistakes in calculating the weight of the bag.

maha

maha:
We took Hassan  for a tx today, it was actually 3 weeks instead of his usual 4 weeks as his tx last time was less than his requirement and also he was also sick this past 2 weeks with gaps inbetween (Gastro entritis). I felt all that vomitting fever and diarhea would have affected his hb but surprisingly his hb was 11.2. The doc refused transfusion as according to them it was clinically unacceptable. I was very disturbed as all the tests are conducted after fixing the IV and now it was useless. We requested if they could transfuse 200ml instead of 250ml and we could come back after 4 weeks since the cannulation was done and it is not easy for Hassan. Now we will have to go back again next week and this time a CBC would be done before admission....more pricking. Is it dangerous to transfuse if the hb is over 11? I am mentally prepared for one pricking session in a month and now next week is going to be a repeatation. Feeling so heavy

maha

Lena:
Maha,

I have many times been transfused with hb 11. It is not dangerous but it is useless. The thing with transfusions is to receive only the necessary ones, not to burden yourself with one more transfusion than what is necessary. It is not clinically unacceptable though, you are not in any danger when in 11(for higher counts it is different),  but it would be better to avoid any unnecessary transfusion.
Remember that a transfusion does not only mean good things--higher hb and so on. It also means higher iron load, infections, reactions - so it is advisable to avoid any unnecessary transfusions like I said.

Lena.

Navigation

[0] Message Index

[#] Next page