Transfusions
Most patients with aplastic anemia will require transfusions of red blood cells and/or platelets. Transfusions should come from the fewest donors possible. If bone marrow transplantation is even a remote possibility, transfusions should not come from family members. Because most patients will require many transfusions over time, all blood products starting with the first transfusion should be leukocyte depleted. That is, all red cells and platelets should be either filtered through a white cell leukocyte depletion filter or be washed prior to administration to the patient. If possible, all blood products should be irradiated as well. Blood and platelet transfusions should be given as infrequently as possible. Many patients with aplastic anemia do not receive routine platelet transfusions. Rather, they should be given such products only when there is evidence of clinical bleeding or prior to invasive procedures. Healthy young patients may tolerate a hemoglobin of between 5 and 7 grams/dl without difficulty. Patients with heart disease or other medical conditions may need higher hemoglobin levels. Patients who become alloimmunized (fail to raise their platelet count in response to platelet transfusions) may have less bleeding symptoms if the hemoglobin is kept between 8 and 10 gm rather than at the lower values.
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Transfusions
