Old donated blood

[Chirley]

Hi,

I am transfusion dependant and require anything between 1 to 2 units of blood weekly averaged out. I received a 2 unit transfusion yesterday and both units were 39 days old. That means they had 3 days to expiry and I wasn't very happy about it but as usual, I didn't say a word, just kept my concerns to myself.

Am I correct? Was it just a case of having a ferritin infusion with very little benefit to be gained? Should I have refused the blood?

The one good thing is that I'm now getting irradiated blood whcih the nurse tells me they only do for people pre and post transplant, maybe my transplant is getting nearer.

Regards

Chirley

[Neil Cuadra]

We're heard different opinions about it, but many patients and even some transfusion experts say that it makes sense for people who need regular and repeated transfusions to receive the freshest blood possible. The freshness of blood should be less of an issue to people having a one-time need, such as elective surgery or blood transfusions after an accident.

The number of units of transfused blood you get can be a negative factor down the road. First of all, iron overload depends on the number of units transfused. Second, patients who are candidates for transplants do best (in a statistical sense) when they have had as few transfusions as possible. For both reasons that means that you want each transfusion to last you as long as possible.

So what's the problem with getting fresh blood if it's available? Having priorities for who gets the freshest blood is apparently a logistical and maybe even an ethical or legal problem for blood banks, and many hospitals and blood banks don't seem to have faced the issue head-on.

That leaves it to individual patients to ask for the freshest blood they can get, and talk to their doctors and blood banks ahead of time (not at the moment the blood is being delivered) to push them toward a policy that matters for your health, and be a squeaky wheel.

Not everyone has the personality to "fight the system" this way, and as patients we certainly have many other things to worry about, but for those who want to make the effort I think there are two approaches worth pursuing:

1. The institution. Talk to people who run the blood bank or the treatment center and ask them why patients who need regular transfusions should not be given priority for fresh blood when freshness is not important to other patients.

2. The doctor. Even if the institution doesn't have a policy to give you the freshest blood possible, ask your doctor if he or she would be willing to make "blood, as fresh as possible" part of his or her orders for your transfusion. The blood bank may be willing to follow the doctor's order.

[Birgitta-A]

Hi Chirley,
I always look at the blood units and they are between 4 and 14 days old. Since I have understood that the blood is best before it is 10 days old I have controlled if fresher blood functions better so I don't need a new transfusion so soon but found no difference. I have so much antibodies that they have difficulties to find blood for me - perhaps they have found that fresher blood is better for me.

Here is a report about fresh/old blood. They have at least two explanations about why fresher blood is better.

The first is that stored blood gradually loses its ability to get oxygen to tissues, largely through loss of a blood vessel dilator called nitric oxide.

The second is that some kind of microparticles play a role in blood clotting and inflammation, and that they start accumulating inside blood bags around day 10.
http://www.cbsnews.com/stories/2010/...n6714971.shtml
Kind regards
Birgitta-A

[riccd2001]

Since Feb.2008 to end Sept.2010 I've had 130 units of PRBCs.

Besides the date of donation, there is also the variation of actual volume amount which for me has ranged from 238ml to 343ml (a difference of 44 per cent is cosiderable).

Another variable to consider as the number of transfusions and antigens increase is the cross/match process which takes longer to do as well as becoming more difficult to find a donor that is compatible.

For me fresh is preferred but compatible match is essential regardless of age.

[Chirley]

Hi,

I was told today by a nurse at the daycare centre that the age of the blood doesn't matter. Then my bloods came back and my Hb was exactly the same as it was 2 days ago before my 2 unit transfusion of blood due to expire in 3 days. So I lost 2 units of blood in 2 days??

So I had to have another 2 units of blood today and guess what? One of them had an expiry date due tomorrow, but luckily the other one expires on the 21st October.

BTW I also have heaps of antibodies and it takes a long time to cross match my blood. I always have O pos, K neg, CMV neg, leukocyte depleted and now irradiated blood. I have a list of 7 or 8 other antibodies (don't know what they are) that are also listed on the blood bag.

I'm always given intravenous hydrocortisone before my transfusions and also have an antihistamine ordered but I refuse to have it because it makes me too tired and therefore dangerous to drive.

Regards


Chirley

[Birgitta-A]

Hi Chirley,
Well, I don't think the nurse is an expert in the field of how blood changes during 42 days when it is frosen. Too bad that you had to get 2 units of blood after 2 days!

I have 4 antibodies (I don't remember their names) and it takes many hours to find compatible blood. Then I get intravenous hydrocortisone before transfusion to prevent hemolysis, like you, but I don't think that has much effect. I think we only have leukocyte depleted blood in Sweden but I don't get irradiated blood.

Have you asked about Exjade and the possibility to get a SCT with cord blood?
Kind regards
Birgitta-A

[Helen Robinson]

Hi Chirley

David has been through these issues. some nurses think blood is like milk and just "goes off" on the due date. His haem said that as the red cells deteriorate they give off cytokines ,similar to those which white cells produce when you are fighting a cold etc. It is these which make you feel yuck after some transfusions particularly with old bleed. The city hospital always gives the freshest best match to the haem patients and this might be the issues. Perhaps that day it was even harder to match you with the fresh donations. His dr said to refuse anything over 5 weeks or only have one bag as it will only be a ferritin tx.

The tx he had in Brisbane was old but must have been a perfect match because it lasted well. Perhaps the donor had a very high HB! There are too many variables in the mix but ask your Dr to contact the blood bank you use and perhaps you could show the CBS news link to the nurses to help others as well.

We told the pathologist at our local blood bank and she was interested enough to talk to the haemotologist and we get fresh blood there now.

I hope things improve.

Helen