Discussion Forums > Thalassemia Major

Low White Blood Cell count

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Sharmin:
Danniel,

Ideally one should transfuse when their hg drops to 9.5, in your case however it would be useful to keep you hg higher until your spleen reduces in size.  For example, our doctor is handling a case in which a young boy has an enlarged spleen (because he was previously monitored by a different doctor who had allowed his hg to remain too low).  In his case, our doctor is not maintaining the hg around 11.0.  He does not receive any more blood then other patients, he is simply kept higher.  He receives a transfusion (14 - 16 cc/kg) when his hg reaches 11.0.  Over time he is not receiving any more or less blood volume per year in total. 

Using this method, this boy's spleen has reduced in size considerably, and this maintenance shall continue until his spleen is completely unpalpable on examination (normal in size).  Even then, his hg will not be allowed to drop below 95.  These days, some doctors even say that the lower limit should be close 100. This will help your bones as well.  Remember, that your spleen is attempting to expand it's surface area in response to the low blood level - in futile attempts of extramedullary hematopoiesis the spleen grows in size - and once the hg levels are kept higher the spleen will stop growing and likely shrink.  The negative effect of a large spleen in thalassemia is that cells in the plasma are rapidly destroyed because of the spleen's immune function - due to the spleens larger surface area many more cells are broken down.  This decreases the hg, causing anemia and the spleen to grow even larger and the problems becomes even worse. 

If you spleen is not putting you in danger in any other way, I would say that hypertransfusion is best for you.  If your spleen shrinks, chances are that your transfusion will last longer. 

Ideally, a patient who does not have an enlarged spleen should be transfused 14 - 16 cc/kg of blood when their hg drops to 9.5-10 (in your case, until your spleen shrinks the lower limit should be 11.0) - and the blood should last about 4 weeks.  In your case, until the spleen begins to shrink that interval may be shorter. 

Very importantly however, you need a proper examination before refusing splenectomy if your spleen is so large that it is putting your life in danger. 

I hope this helps,

Sharmin

Danniel:
I took a look at my last abdominal ultrasound from november 2010...and my spleen sizes are :

LONGITUDIONAL DIAMETER: 182 mm
TRANSVERSAL DIAMETER: 77 mm.......

The doctor who took my ultrasound said that my spleen is a little enlarged.....but that there is no way of removal!

Do you think now that i should try hiper-transfusing with my actual spleen size?

Danniel:
New updates today :
My Hb is 8.5 now and I'm going to transfuse Thursday and Friday....now I officially begin my "hiper-transf. program" if I can say that.
My Hb dropped 1.5 in a week and a day....is this ok or it's a fast drop?
According to this my doctor said I should transfuse every 10 days until my pre-tx Hb is 9.5
If this doesn't work, she said I should remove my spleen ...and this is not good news to me...

Sharmin:
Dear Danniel,

I really think your doctor needs to give your body a chance to shrink your spleen.  At this point you hemoglobin should not be allowed to drop below 11. 

Sharmin

Danniel:
Thursday and Friday I had my transfusion.

440 ml in 2 packs of blood .......after transfusion my Hb= 11.0, and I'm going to have another pack next friday!

I'm just glad that doctors agree to this :D
I'll keep you updated!

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