Thalassemia Patients and Friends
Discussion Forums => Thalassemia Intermedia => Topic started by: Lokkhi maa on May 11, 2015, 11:53:02 AM
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Dear Andy,
My baby is now 19 months old and getting transfusion every 6/7 weeks duration.After getting transfusion always her body temperature increase from 97 to 99 or 100.But this time after complete her transfusion her temperature was raised up to 102.She suffered two days from fever.Now today after 6 days of her transfusion her temperature is again 102 to 103 and some blood has came with her stool.I can't understand is it for food poisoning or another reason.I am also worried to think about her HB also.May be it has reduce for fever.Now I decide to give her anti biotic which may also will be decrease her HB.But what we will do?Please give your opinion and help us pls......
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It sounds very much like a reaction to antibodies in the blood. Often, an antihistamine is given before the transfusion to reduce the reaction. Talk to your doctor about this. Antibiotics are not usually called for in this circumstance.
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Hello Andy,
Last time my baby was taken transfusion after 60 days when her hb was 9.20.But this time after only 43 days her hb is 8.3.I think its her fever effect.For that we decide tomorrow give her 11th transfusion....Feeling so much sad :sadyup :sadyup and also worried for fever :shocked :quiver.According to your advice I will give her antihistamine before the transfusion.. :smileblue
Pray for her....
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It's not unusual to see Hb drop if a child has been sick. Don't be too worried. It's something that happens occasionally.
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Hello Andy,
Yesterday my baby was taken antihistamine as "Alatrol" before transfusion but no change Andy....When she completed her transfusion then her temperature raise up to 102 over and now her fever is 101.2.From yesterday she suffering from fever and we trying with every thing but its not drop from 101 to 100...Doctor advised "don't worry,it is antibodies reaction".
This is my babies 11th transfusions.After taking Last 2 transfusions she suffered by fever.But earlier transfusions no problem.Why she is now suffering?Is there any health problem?Earlier antibodies not affected but now why?
Andy, in this situation will hb drop for fever?
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The more transfusions a patient has, the more the chance of antibody reactions. Perhaps a different antihistamine can be tried, like benadryl. One other possibility is to administer a steroid before the transfusion.
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I agree that another antihistamine will be helpful. It is also very important to determine what antibodies your daughter has developed and to avoid giving her blood with those particular antigens in the future to avoid reactions or fever.
My son also began developing antibodies around the age of two. Antibodies develop as a reaction to certain antigens - that is why they were not present before. Don't worry, if doctors avoid giving your daughter blood containing the particular antibodies your daughter has developed she will be fine.
Best, :hugfriend
Sharmin
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Thanks Andy and Sharmin...
For the fever hb level will be drop or not ?
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It's difficult to predict Lokkhi maa, sometimes it does and sometimes it doesn't.
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Dear Andy,
My baby has already taken 11 transfusions in her 22 months old and she suffered from fever last 2 times after taking transfusion from the new two persons who are not donate her earlier.
Andy,if my baby again take transfusion from them then the same problem will be arise or not? ??? I am really confused and also worried for her next transfusion. :dunno Whats your decision this time I give my baby benadryl to avoid the fever? ???
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Yes, try benadryl before the transfusion begins.
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Dear Andy,
Only 1 dose before transfusion ? Next dose ??
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In Canada, the doctors usually give one dose of Benadryl before transfusion. No dose after the transfusion. This is just precautionary measure. If the fever persists after transfusion, check with the doctor for guidance.
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Hello Canadian_Family,
Thank you for your reply.Last time I was given my baby 5 ml Alatrol before 2 hours of transfusion.During transfusion no problem but after completion fever was 101 to 102...
For that this time I am confused what will we do? Could my baby take transfusion in future from those donators by whom she got fever after transfusion ....
Please advice..
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I would investigate the underlying cause of fever after transfusion (see if your child has developed antibodies that reacts to antigenes). If you have donors from same group of people, you may choose to switch the donors and see if the fever is gone.
Sometimes, antibodies in the recipient’s blood can attack the donor blood if the two are not compatible (this may be the case for your child). If the recipient’s immune system attacks the red blood cells of the donor, it is called a hemolytic reaction. If the recipient’s immune system attacks the white blood cells of the donor blood, it is called a febrile reaction. In haemolytic reaction, the haemoglobin drops quickly requiring frequent blood transfusion. In febrile reaction, the symptoms include fever.
Do you mind sharing if the fever was accompanied by chills and shaking in your child.
Try switching the donor as first step.
Ask your doctor if a different antihistamine is required.
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Hello Canadian_Family,
Thanks for your nice reply.Yesterday my baby got her transfusion and again she is now suffering from fever.
Hello Andy,
This time I also gave her Adryl 5 ml before transfusion and taken time 4 hrs. Bcoz last time transfusion was completed early so this time we take time.But no result.
The same donor donate her earlier then she was ok but now why fever came? Last 3 transfusions my baby suffered by fever and always it is 101 to 103.
Last 3 times after complete the transfusions fever came with chills and shaking.Doctor advice for injection (forgot the name) but not confirm about fever.
Please help me.....
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Is the blood being filtered?
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Dear lokhi maa
My baby hardik had also gone through these situations..... And when we talk to doc they advice us to take the blood of SAGM(already filtered by removing WBC during storage)....as I don't have donors so use donated blood.....and to use filter at transfusion time.....and the results are positive....he doesn't get fever....
As u have available donors......just try to talk to blood bank to remove excess WBC ,Platelets.... And all which are not required and contribute in developing antibodies and..... as baby 's body only need RBC so it is safe to remove excess part....and then use leukocytes filter..... I think u will surely succeed
Praying for u
Neha
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Hello Andy and Hardik,
Thanks for your reply and sharing your experience.
We just only removed Platelets and give her packed cell.I have no idea about removing WBC.I will sure discuss about it.
Andy can't understand by filtered...WBC and Platelets are not same ? ???
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Dear lokhi maa.....
No WBC and Platelets are not same,they are two different things having different functions. WBC work as guard and Platelets have healing properties..
I think Andy also means of using leukocytes filter....or called bed side filter
Or may be he is talking about NAT tested blood
Leukocytes are wbc only according to my knowledge..... WBC guard our body against foreign particles....and if we introduced more WBC in body through transfusion.....more antibodies will be produced to guard our body by breaking more RBC as thalassemic RBC are of irregular shape not recognized by wbc so ....results fatal.....thus it is better to use leukocytes filter...
I dont know much and Better explanation can be given by Andy only......
Waiting for Andy's reply
Neha
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Lokkhi, yes I am talking about a filter that goes in the line when the child is transfused. The filter blocks white cells and platelets from getting through. If the blood has not been pre-filtered, this is necessary. Even with filters, occasionally, bits of white cells or platelets get through that can still cause a reaction, but this doesn't happen often.
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Thanks Hardik and Andy.What a lot of experiences you have :smiley Its great.. :smiley
I will discuss about removing white cell but don't know will it be possible or not ???
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Hello Andy,
Next Friday my baby will take her transfusion and we have already discuss about removing WBC and Platelets.But they confirm us in the packed cell there is nothing except RBC.They remove all like WBC,Platelets and other elements also.
My baby always take fresh blood and we give her Adryl before transfusion.But from last few transfusions she suffered by fever after complete or ending moment of transfusion which are not in earlier.
We also mark that which donor earlier donate her then she was normal but now suffer fever. Whats the reason and what to do ??? ???
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They are correct in saying that packed cell contains only RBC.
In transfusion medicine, packed red blood cells (sometimes called stored packed red blood cells or simply packed cells) are red blood cells (RBC, also called erythrocytes) that have been collected, processed, and stored in bags as blood product units available for blood transfusion. The whole blood is processed to remove WBC, Platelets from RBC.
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Now what we will do for avoid fever?
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Lokkhi,
It really depends on how the red blood cells are prepared. If the red cells are simply separated by centrifuge, fragments of white cells will still be there. If the red cells are leukocyte depleted, then they have been filtered to remove the white cell fragments. If this has been done, the only treatment is to give an analgesic like ibuprofen with the transfusion.
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Dear Andy,
Whats the effect and how much harmful fever after transfusion for health?As Adryl not worked earlier so may I leave it or continue to my baby?
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As long as the fever is low, <102°, then there is no effect from the fever. Many patients deal with this by taking an analgesic.
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Hello Andy,
Thanks for your reply.
Last Friday was my babies transfusion day and a very very bad experience for me.
This time donor was a new person and we start transfusion after giving her Adyrl and Napa (Fever medicine) 5 ml respectively.But only half an hour fever came and her whole body shaking rapidly.Fever was low 100 but shaking was too much.My babies hand and throat was shaking rapidly and continue it 15 to 20 minutes.Its really horrible.
Doctor gave her fever suppository and said to stop transfusion for some times and a wet towel keep on her forehead up to finish transfusion. After 1 hr temperature reduce and start again transfusion 8 drops in a minute.At last we have finished the horrible transfusion after 7 hrs as 12 drops in a minute.
We came home with low fever in evening and gave her again suppository and fever medicine timely but in mid night again shaking raised and stay 10 minutes.This time shaking done very much rapidly than earlier.
Last 5/6 times fever came after transfusion but now to much early though giving her Napa and Adyrl also.We marked that the fever stay minimum 1 day and not reduce by any medicine.We finished her transfusion maximum in evening and next day up to noon it stay.Then she recover normally.
Now my baby is fine..
Whats the reason for shaking ?? I don't want to face the same situation in next time.
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Lokkhi,
It is standard practice to stop the transfusion once the child started to shake. This is most likely what is called a febrile non-hemolytic transfusion reaction. Again, filtered blood is most important, but this can still occur in very small percentages of transfusions, even when the red cells have been filtered. It is not considered to be a serious issue, but transfusion is stopped unless the cause of the reaction has been easily identified. It can be resumed at a slow rate when other types of transfusion reactions are ruled out.
This link describes this type of reaction and what to do about it.
http://www.transfusion.com.au/adverse_transfusion_reactions/febrile_non-haemolytic
Febrile non-haemolytic transfusion reactions (FNHTR)
This is an acute (<24 hours), immunological transfusion reaction.
When to suspect this adverse reaction?
Patients present with an unexpected temperature rise (≥38ºC or ≥1ºC above baseline, if baseline ≥37ºC) during or shortly after transfusion. This is usually an isolated finding. Occasionally the fever is accompanied by chills.
Chills, rigors, increased respiratory rate, change in blood pressure, anxiety and a headache may accompany this reaction but occur in several more serious transfusion reactions also, the most serious being acute haemolytic reaction, transfusion associated sepsis and TRALI. FNHTR is a diagnosis of exclusion.
This occurs in 0.1% to 1% of transfusions with leucocyte depletion.(1)
Usual causes?
Cytokine accumulation during storage of cellular components (especially in platelet units) is thought to be the most common event leading to symptoms of FNHTRs. Cytokines are released by white cells and pre-storage leucodepletion has reduced this risk.
FNHTR is also caused by the presence of recipient antibodies (raised as a result of previous transfusions or pregnancies) reacting to donor human leucocyte antigens (HLA) or other antigens. These antigens are present on donor lymphocytes, granulocytes, or platelets.
Investigation
Clinically assess the transfused patient for fever, chills, rigors and headache.
Acute haemolytic reaction may need exclusion.
Direct antiglobulin test (DAT), blood count and repeat ABO grouping may be indicated. Consider investigations for transfusion associated sepsis.
In patients with repeated FNHTR, investigation for HLA antibodies may be useful.
What to do?
Stop transfusion immediately and follow other steps for managing suspected transfusion reactions.
Treat the fever with an antipyretic. However, avoid aspirin in thrombocytopenic and paediatric patients.
Consider and exclude other causes, as fever alone may be the first manifestation of a life threatening reaction.
Rule out acute haemolytic reaction, transfusion associated sepsis and Transfusion-related acute lung injury (TRALI).
Recommencement of the transfusion, at a slow rate, is possible if other causes of a fever have been excluded.
References
Roback JD (ed). Non-infectious complications of blood transfusion. Chapter 27, AABB Technical Manual, 17th edition. AABB, Bethesda, 2011.
Popovsky M (ed). Transfusion reactions, 3rd edition. AABB Press, Bethesda, 2007.
Callum JL, Lin Y, Pinkerton PH, Karkouti K, Pendergrast JM, Robitaile N et al. Chapter 5, Transfusion Reactions. Bloody Easy 3: Blood Transfusions, Blood Alternatives and Transfusion Reactions: A Guide to Transfusion Medicine, 3rd edition. Canada: Ontario Regional Blood Coordinating Network, 2011. [cited 2012 Sep 13]. Available from: http://transfusionontario.org/en/.
- See more at: http://www.transfusion.com.au/adverse_transfusion_reactions/febrile_non-haemolytic#sthash.X1WNlBiz.dpuf
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Thanks Andy for the helpful information.
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Dear all,
Thanks to all of you for sharing valuable all information's.
Last night we discussed with doctor about fever.Finally he advised to use leukocytes filter.
Dear Hardik,
Please share me about the process..
Dear Andy,
Same donor but earlier no fever after transfusion but now why?If my babies antibodies react donor RBC then the fever problem why not arise earlier?
Really confused.
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Lokkhi,
When no filter is used, it makes it easier for small fragments of white cells to remain with the red cells. Even with the same donor, this can be an issue when the white cell fragments are left in the blood. Using a filter should make a difference.
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Thanks Andy.
In Bangladesh leukocytes filter is only available in Dhaka.I really got wondered.Though its not easy to get and have some formalities to purchase and too much expensive also but we will must collect before the next transfusion.
Hope next time it will be a safe transfusion...
Feeling sorry to think about the other thal babies who have suffered the same as my baby but family has not the capacity to support all essentials as need a thal baby.
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Hello Andy,
One week ago I collected leukocytes filter and last Wednesday my baby has completed her transfusion safely.We feel also happy that leukocytes filter is workable and my baby got relief from all sufferings during transfusion.
We return to home then after 2/3 hrs her temperature low increase but in mid night it increase same as earlier 102 to 103 and also shaking her whole body with fever.After sufferings 1 day with the high temperature now she is fine.
We cant understand ???
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Hello Andy,
Please reply...
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Hello Andy,
One week ago I collected leukocytes filter and last Wednesday my baby has completed her transfusion safely.We feel also happy that leukocytes filter is workable and my baby got relief from all sufferings during transfusion.
We return to home then after 2/3 hrs her temperature low increase but in mid night it increase same as earlier 102 to 103 and also shaking her whole body with fever.After sufferings 1 day with the high temperature now she is fine.
We cant understand ???
Please give me a suggestion on above situation..
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Same problem with my daughter on every transfusion.
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Hello asefweb,
Your daughter also use leukocyte filter during transfusion?
Please Andy help us to understand the reason.
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Even with filters, small fragments of white cells and platelets can sometimes get through and cause a mild reaction. It is also important that the blood is being matched properly.
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:hysterical :hysterical :hysterical :hysterical
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Hello Andy,
This time my baby is fever free after transfusion.She is fine.
Before transfusion I gave her 5 ml Adryl and used leukocyte filter...
Thanks a lot... :smiley
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Glad to hear that there is progress.
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Hello Andy,
Last 7/8 months my baby was fine after using leukocytes filter.But yesterday she got serious allergy problem with fever during transfusion.We used leukocytes filter but why the problem raised ?
She got transfusion from this donor earlier also but that time she was fine..
Please advice..
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Hello Andy,
Please reply..
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Even with using filters, sometimes fragments of white blood cells still get through with the transfused blood, and this can cause the reaction. As a precaution, consider using an antihistamine before the transfusion begins. If the problem repeats, a Coombs test should be done to see if it is an antibody reaction.
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Dear Andy,
My baby is now 4 yrs old and her weight is 18 kg.She takes transfusion after every 4 weeks when her HB 9.50 to 10.00.
As there are various donor donate then packed cell quantity also vary every month.Sometimes it above 250 ml or sometimes 200 to 220 ml. For that every patients HB should vary..So patients HB sometimes drop early than last time.
For this problem what to do? What is the standard transfusion calculation? Per kg 15/20 ml ??
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I'm not sure there is a solution other than taking an extra bag of blood, and that may not be possible.