Thalassemia Patients and Friends
Discussion Forums => Thalassemia-related Issues => Topic started by: anupam on March 03, 2011, 10:19:12 AM
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Hi Everyone,
My wife is 26 years old Thal Major. She undergoes regular transfusion at a hospital in New Delhi. She and many other patients in the Thal ward face a big problem. The leukocyte filter clogs frequently. It happens after random durations and after random quantities of blood has been transfused. It can never be predicted. We've tried many things---raising the level of the blood bag, flushing, lowering the arm, different veins, using a blower-heater near the vein---but nothing is helping. Consequently, almost every time, we end up wasting some blood because neither can the patient take the pain of further pricks nor can s/he wait after the hospital closing hours. I cannot overemphasize how frustrating this has been for all of us at our hospital. Many people associate it with winters. But I have seen this happen even in summers. We use Pall filters. We follow the instructions given on them. I have not found anything on the Internet that gives any idea why this happens. Any help from the forum will be deeply appreciated.
Thank you!
Anupam.
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Hello
Something similar happened to me some years ago and it had 2 reasons (don't know if it is going to be the same case but i'll explain it just in case).
In my case, the filters made the transfusion going slow and consequently, there wasn't a good flow so the blood coagulated at the plug. At the beggining and for lots of months we thought it was the vein that has collapsed but then we saw it was that plug what stopped the trasfusion. We change it into one of those that have 3 entries and it worked.
Some time later, they changed the filters for the ones we have now and it stopped going so slowly but everytime we have tried to use a normal plug, the blood coagulates and they had to remove it. Sometimes, it still coagulates but it happens on the catheter so we use some serum to free the vein and if works again.
I'll attach some images just to make myself understand cause it is something very difficult to explain in a foreign language. They're not exacly the ones I use or I used but I think it will be easy to catch the idea.
Hope it helps you.
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Hi Laura,
Thanks for your reply! You have given some direction in which we can work. The filter we use is like your previous filter. I have a question though - your current filter does not have a leukocyte filtering box. Is that recommended? Doesn't it lead to more reactions than your previous filter?
Thanks.
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Hi,
The blood is already filtered before the transfusion. Then they use that filter just to make sure there is no leukocytes. I only had a little reaction when I was a child (like 18 or 19 years ago) and since then I've been pre-medicated just in case but we forgot about it a couple of times and nothing happened.
I suppose it depends on the process that the blood "suffers" before arriving to us. In my case it is treated, taken apart leukocytes and then preserved like at 4ºC I think (to be honest I've never asked about it, it's just what I heard some time ago).
Hope it helps.
Laura.
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Thanks! That helps. Pre-transfusion leukocyte removal is still not the norm here in India.
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Anupam,
You should ask the hospital as to whether they are "washing" the blood or not? If the answer is yes, you can try without the leukocyte filter. If no, then you are stuck. I presume that they are at least transfusing packed cells, and not whole blood?
cheers
Poirot
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Thanks Poirot. The International Red Cross here does provide pre-filtered blood. But that is a more expensive and time-consuming option . The packed cell blood that we get right now is free of cost for thalassemics. I guess till we're ready for the expense of pre-filtration, we'll stick to filters.
You will not believe how big a problem filter clogging is here in India (especially in the government hospital we go to). A lot of blood is wasted. Children have to suffer multiple punctures. Filters are expensive, so a lot of money is wasted. Hopefully Laura's tip about using 3-inlet 'T' will help.
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Dear Anupharm
from where u buy filter
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Rehman, we buy filters from a chemist's shop near the hospital. He stocks the filters approved by local thalassemia society. These are Pall filters and cost around 700 Indian Rupees.
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anupam
when does ur wife's filter start clogging? i mean is it after the blood bag is over and only the blood from the i.v set leading to the filter is remaining or is it bfor the blood bag is over?
i also use pall filters. i get them from India. and i think they cost more than 700. i am not v sure. must ask my husband.
shaziya
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Shaziya, the clogging can happen any time. Five minutes after transfusion begins or half an hour into it or even when the second unit begins. It is totally unpredictable. The common wisdom here is that the clogging happens inside the filter. But from Laura's answer, I am no longer so sure. The clogging could be happening in the scalp vein set or the canula. Last time, we used a 3-way inlet with saline on very slow drip along with the blood and there was absolutely no clogging. So, maybe Laura is right. But we can be sure only after this performance is repeated consistently.
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Anupam,
Dude, I am in India - Mumbai to be precise! So, am aware of some of the issues.
In our thal centre (I think our centre is probably the best in India based on anecdotal evidence, probably one of the best in the world, care wise), only one thal was using the leukocyte filter - and that was because she had an antibody issue. Rest of us just use the plain filter (Fig 1 posted by Laura). BTW, our centre is also run by Mumbai Red Cross.
I would strongly, strongly recommend moving to washed, filtered blood, if that is an option for your wife - from an economics perspective, the filter costs Rs700, how much does the filtered blood at Delhi Red Cross cost per unit?
Cheers
Poirot
Thanks Poirot. The International Red Cross here does provide pre-filtered blood. But that is a more expensive and time-consuming option . The packed cell blood that we get right now is free of cost for thalassemics. I guess till we're ready for the expense of pre-filtration, we'll stick to filters.
You will not believe how big a problem filter clogging is here in India (especially in the government hospital we go to). A lot of blood is wasted. Children have to suffer multiple punctures. Filters are expensive, so a lot of money is wasted. Hopefully Laura's tip about using 3-inlet 'T' will help.
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Poirot, Hey! Sorry I didn't see your location earlier! :)
Actually, I do not know how much it costs to get pre-filtered blood. I MUST find out. The only problem here is that our centre is not run by Red Cross. If one needs washed blood, one has to go to Red Cross the day before and get some extra tests and formalities done. Since your centre is run by Red Cross, it must be getting it directly. All said and done, washed blood is definitely a better option and now I'll seriously explore it.
Thanks! :)
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Okay, Good luck.
BTW, transporting blood will bring its own set of issues - the primary one being the "life" of washed, packed cells. Have you checked with the local thal association for alternative centres, especially for specialist thalassaemia centres?
cheers
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Poirot, thank you for the fresh look.
I've no idea what you guys are talking about. I hav ben given washed blood all my life. I hope it will be standard in every part of the rule too. Weren't Bill Gates and his wife last week in India? I know they do anit malaria things. Time someone goes waving witha thlassemia flag under their nose. Why can't thalassemia be not an issue of chairty? Maybe that is also not smart and do you need to motivate people from within. Well, I let me say that I say nothing.
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anupam
sorry i have not been able to reply early. thanks for clarifying. actually as i have mentioned earlier i also use PALL filters and and get them from india. so far i hav not come across this problem of clogging. that is y iasked u at what stage it starts clogging. iand each filter costs me 1400 indian rupees.
thanks
shaziya
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Poirot, thank you for the fresh look.
I've no idea what you guys are talking about. I hav ben given washed blood all my life. I hope it will be standard in every part of the rule too. Weren't Bill Gates and his wife last week in India? I know they do anit malaria things. Time someone goes waving witha thlassemia flag under their nose. Why can't thalassemia be not an issue of chairty? Maybe that is also not smart and do you need to motivate people from within. Well, I let me say that I say nothing.
Welcome, Dore. In the great country that we call Bharat aka India (4th largest economy in the world), getting safe blood still remains THE key issue for most thalassaemics - I shudder when I think of thals in non-metro cities in India. I have been lucky to have had access to good quality blood from the start, thanks initially to the Tata Trusts (India's version of the Gates and Buffet) and then Red Cross - but, it still remains a challenge for most thals in India.
RE: Malaria vs Thalassaemia - I guess it is a question of numbers. It is ironic that Thal will remain an orphan disorder, until enough number of people have the disorder globally, at which point in time you have a health crisis, to make it worthwhile for policy makers to pay attention!
As you can see, I am feeling very grouchy/cynical today.
Cheers
Poirot
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Hello!
How are things? Did you try any of the options we talked about?
Kisses,
Laura.
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I think you guys in India are luckier and have better access & facilities for thal.
Leuco-depleted or 'washed' blood isn't always available at the red-cross here (in Indonesia). They said they only process it if the blood bag is >400cc, and therefore need bigger donor (physically). :dunno
So, I use packed cell with filter sometimes. The price is higher in this case, since the PALL filter is not easy to get (around 3x pricier than yours). About the clogging, my doctor said once it's because incorrect procedure during filter installment (so air bubble enters the filter somehow) or the blood wasn't saved in the right temp.
I hope things will get better and filtered blood will be a standard in SEA countries.
~Nat
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I share that wish. Also thank you for your answer Poirot.
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Hi
anupam... i also use the leucocyte filter same as laura showed in the pic.... in the start i was also having the same problem that i have to waste the half or quarter blood bag at the end because of the slow speed due to filter and i get frustrated because i have to waste the whole day...... but then i have found a solution for me ... as i start my transfusion i hang my blood bag at maximum hight (i put the blood stand on chair or table and sit on sofa) u can put the blood stand at chair..:) and starts it at good speed by doing so it does not stop and ends in proper time......i don't know whether u like this suggestion or not but i thought i should share may be it will help u...:)
And here some doctor says that washed blood raises less Hb as compare to non washed...so they say it is better to use filters..what you people say about it???
thanks
laiba
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Frankly, the cost of washed packed red cells is the main reason they can't be used more, so the filter is absolutely essential.
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but here there is no cost for washed blood red cells.... because the blood bank is of Government.... may be they do something different which has no more cost... :-\..
hmmm..... :huh here they use normal slien (drip ) in wash process... :rolleyes
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Does the blood bank make washed red cells available?