Blood transfusions

Treatment for leukemia can cause severe anemia (a low number of oxygen-carrying red cells). The normal life of a red cell is three to four months and, as old cells die, the diseased (or suppressed by treatment) marrow cannot replace them. Many children require transfusions of red cells when first admitted and periodically throughout treatment.

Whenever my son needed a transfusion, I brought along bags of coloring books, food, and toys. The number of VCRs at the clinic was limited, so I tried to make arrangements for one ahead of time. When anemic (hematocrit below 20 percent), he didn't have much energy, but by the end of the transfusion, his cheeks were rosy and he had tremendous vitality It was hard to keep him still. After one unit (bag) of red cells, his hematocrit usually jumped up to around 30.

One bag (called a "unit") of red cells takes approximately two to four hours to administer and is given through an IV or catheter. If your child develops chills and/ or fever during a transfusion, the nurse should be notified so that the transfusion can be stopped immediately.

There are some risks of infection from red cell transfusions. Since new tests have been devised to detect the AIDS virus, the risk of exposure is minuscule, less than 1 in 450,000. Although there are excellent tests for the various types of hepatitis, exposure to this disease is still possible (the risk is less than 1 in 4,000). Exposure to cyto-megalovirus is also a concern. These risks are the reason transfusions are given only when absolutely necessary.

My daughter received several transfusions at the clinic in Children's Hospital with no problems. After we traveled back to our home, she needed her first transfusion at the local hospital. Our pediatrician said to expect to be in the hospital at least eight hours. I asked why it would take so long when it only took four hours at Children's. He said he had worked out a formula and determined that she needed two units of packed cells. I mentioned that she only was given one unit each time at Children's. He called the oncologist, who said it was better to give the smaller amount. We went to the hospital, where a unit of red cells was given. Then a nurse came in with another unit. I questioned why he was doing that and he said, "Doctor's orders." I asked him to verify that order, as we had already discussed it with the doctor. He went into another room to call the doctor, and came back and said the pediatrician thought my daughter needed 30 cc more packed cells. I called Children's and they said she didn't need more, so I refused to let them administer any more blood. It just wasn't worth the risk of hepatitis to get 30 cc of blood. Even though I was pleasant, the nurses were angry at me for questioning the doctor.

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