How much blood?

[Alison]

Hi All, my Dad was diagnosed in May 2007 with MDS. He has had an incredibly tough year with ups and downs resulting in him going into ICU with a terribly bad respiratory infection in October 2007. The doctors weren't holding out much hope but he pulled through THANKFULLY! His counts are generally low i.e. RBC ranging between 4.8 to 6.8 , platelets 0.2 to 4 (he last received platelets mid-Feb '08). He has been transfusion dependent from the start and has just completed a third cycle of Vidaza.My question is how many units of blood a person can receive at any one time.His RBC dropped to 4.8 two weeks ago and received 6 units. We live 3 hours from Johannesburg in a town called Nelspruit. He has to travel to Johannesburg to consult his Haemotologist. In the interim he consults with a GP in Nelspruit. He saw his Haematologist after receiving the 6 units and she says that she never gives more than 2 units at a time as the Spleen is likely to act as a sponge to the remaining units. We're not sure what to do. He is going in for another transfusion this afternoon as his blood is down again to 6.8. The doctor has recommended 4 units but we're obviously questioning whether we shouldn't let him have 2 units at a time? Have any of you out there any advice? Thanks

[Birgitta-A]

Hi Alison,
Your father and I were both dx May 2006 with MDS and have been transfusion dependent from start. I always get 2 units when I get RBC:s but I think 3 and even 4 could be OK. Here is a link about transfusions:
http://www.cancerbackup.org.uk/Treat...odtransfusions
Kind regards
Birgitta-A
69 yo, MDS Interm-1 dx May 2006, transfusion dependent, Desferal four days with transfusion, Neupogen 2 injection/week, waiting for Eltrombopag for my platelets (now 42)

[Marlene]

The most John got at one time was 4 units. That was when he was first diagnosed. His HGB was 5.5 and they wanted to get him above 9 before letting him go home. They ususally only do two units because most people get transfused when their HGB drops to around 8 and two units will bring it up enough. So if he's at 6.8 and only gets two units his HGB won't be much past 8.

It's critical to set a transfusion goal with your doc. That means that anytime your HGB drops to that level, you get a transfusion. If you monitor your HGB closely then you can get in for transfusion sooner and not require more than two units.

Part of the problem of getting more than two units, apart from the time it takes, is that it's alot of fluid and can be strain on the body especially for the elderly.

[Wendy Beltrami]

Marlene is right...
I know in Grant's case, he has never gotten more than 3 units at a time but when he does get 3, he is given Lasix (a diuretic) between the 2nd and 3rd unit to get rid of some of that excess fluid. Someone please correct me if I'm wrong but I think the concern is that with too much volume being transfused, blood pressure can become dangerously high.

Wendy/mom to Grant
dx 12/4/98 AA

[Marlene]

Hi Wendy,

I don't know about the blood pressure. John's would always stay on the low side. Sometimes it would get borderline too low during transfuions. I think the premeds had something to with it.

Marlene

[Alison]

HI There

Thanks so much for the advice. We have decided not to exceed 3 units at any one time. We will be meeting with my Dad's haemotologist on THursday and will discuss the option of a diuretic. In the interim we are going to try and manage his goals with his doctor as suggested so that he doesn't drop below 8 but rather to "top-up" from there.

Regards

[coenraadbrand]

Allison, we would like to make contact with you to find out which medical plan you joined in order to put in a claim for vidaza? Regards. Coenraad Brand

[Greg H]

Hi All!

On the rare occasions when my Hgb has hit the low 6s, my doc has ordered up three units. I've had them all in one sitting, without diuretics, to no ill effect (other than a tired behind!)

On the other hand, I don't qualify as "elderly" yet (I hope!), so maybe there's less concern about fluid in my case.

Take care!

Greg