Transfusions Treating the symptoms of aplastic anaemia with blood transfusions What are transfusions? Transfusions are used to treat the symptoms of aplastic anaemia, such as low red blood cells and platelets, with blood and platelet transfusions, and anti-microbials (which include antibiotics, anti-viral and antifungal drugs) to prevent and treat infections. Shingles Antiviral treatments e.g. acyclovir: Shingles is caused by reactivation of the chicken pox virus. Most people have had chicken pox in childhood, and the virus lies dormant in nerve roots, and can become reactivated when the immune system is not working properly. Antiviral treatments reduce the risk of getting shingles, which can be uncomfortable, and occasionally life threatening. Shingles vaccine: If you are over 65 your GP may offer you the shingles vaccine: the standard vaccine is a live vaccine and you should NOT receive this. Speak to your GP If you are over 50 with a severely compromised immune system as you may be suitable for the non-live SHINGRIX vaccine. If your neutrophil count is less than 0.5x10*9/l, you will be commenced on the following: Prophylactic antibiotics: These are antibiotics to reduce the risk of spontaneous infection. It however does not completely reduce the risk, and if you have a temperature over 38oC or feel unwell you MUST ring your hospital immediately (you should be provided with an emergency contact number). Antifungal treatment e.g. itraconzole, voriconazole, Posaconazole: Patients who have prolonged neutropenia are at risk of fungal infections, in particular of the chest. This can be very serious and the risk is reduced by treating you with a prophylactic antifungal treatment. Side effects: These can cause liver function abnormalities, nausea or diarrhea - if these happen you may be changed to a different antifungal treatment of an antifungal intravenous treatment. Patients’ experiences When going in for my blood transfusions I have already had my crossmatch the day before and my team have the blood ready and waiting for me when I arrive. The process is pretty simple. I have a cannula fitted and I am checked before and during the transfusion. It’s painless and doesn’t feel uncomfortable at all. Afterwards I normally feel a little tired and have a longer sleep that night but then I feel fine the following day and have more energy. - Claire At the start of my diagnosis I was given 1 bag of blood each week. I was tired just from the illness itself, so attending hospital two or three times a week was difficult. However I knew the blood and platelet transfusions were saving my life. It was just a process I had to go through, and was so much easier once I had my PICC line. - Paula When I first got diagnosed and needed blood and platelet transfusions once or twice a week it involved lots of waiting around. My hospital would take my blood and I would wait about an hour for the results. They would then order my blood products to arrive a couple of hours later. The actual transfusion involved having a cannula into my vein and then platelets would take 30 minutes and one unit of blood would take 90 minutes to transfuse. Sometimes I would need 2 units so I would take lots of snacks and a box set to watch and settle in. I always got a comfortable recliner as I would be there the longest. The transfusion itself was painless and after a set of observations I was free to go. The whole process was much nicer when I had my PICC line which I could have my blood taken from for testing and used instead of a cannula. It made such a positive difference to the whole experience. - Laura Blood Products When patients receive a transfusion Most patients with aplastic anaemia who need treatment will require transfusions of red blood cells and platelets. The threshold for receiving red cell transfusions varies from patient to patient, and is dependent on patient and disease related factors. Red cell transfusions One unit of transfused red blood cells typically raises the haemoglobin level by about 10 g/L. How many cell transfusions a patient may need is variable and dependent on a lot of factors. Repeated red cell transfusions given over many months will lead to accumulation of iron in the body, which may deposit in various organs of the body, but mainly the liver, heart and the endocrine organs. This can later produce problems with the heart and hormoneproducing (endocrine) glands unless precautions are taken. This can usually be averted by starting iron chelating (neutralising) medicines and your medical team can assess your suitability for such medications. Red cell transfusions may need to be given cautiously, and sometimes with diuretics (water medicine), to ensure there is no build-up of fluid in the lungs. This may be especially true for people over the age of 70. Platelet transfusions Platelets are shorter-lived cells. A single unit of transfused platelets should raise the platelet count by 10-40 x 109/L for about two to five days. Response to platelet transfusions is much more variable from one patient to another. Sometimes patients develop antibodies to platelets and special donors have to be found by the transfusion service. The threshold for platelet transfusions can differ and be dependent on bleeding symptoms or problems, or special circumstances such as needing surgery or treatment with Anti-Thymocyte Globulin (ATG). When will platelet transfusions be given? The classification of requiring a platelet transfusion falls into one of two indications: either ‘therapeutic’, to treat bleeding, or ‘prophylactic’, to prevent bleeding. Routinely, prophylactic platelets will be given to patients when a platelet count falls below 10 x 10^9/L. In patients who are showing signs of a fever, the threshold is raised to 20 x 10^9/L. Therapeutic platelet transfusions will be given to patients who are actively bleeding. The threshold or target platelet count will be determined by the severity and location of the bleeding upon clinical assessment. Some patients fail to derive the benefit of getting a platelet transfusion (they fail to show an increase in platelet numbers after a transfusion). This can be because of patient related factors (eg. fever) or higher consumption of some drugs but also because of antibodies that may have developed in the patient from previous sensitisation. Your medical team will carry out appropriate tests to investigate this. Some patients may need Human Leukocyte Antigen (HLA) matched platelets, which again have to be a special order from NHS Blood and Transplant (NHSBT), and require advance notice and on occasions, more time. Key facts Red cell transfusion - A blood transfusion is a procedure in which blood is given to you through an intravenous (IV) line Platelet transfusion - A platelet transfusion is used to prevent or treat bleeding in people with a low platelet count Common side effects Perhaps one of the most common side effects of red cell and platelet transfusions are fever and even rigors (shaking). These symptoms are usually self-limiting, ultimately resolving themselves without treatment. These can be controlled with injections of hydrocortisone (a short acting steroid) and Piriton™, a strong antihistamine that can make you feel sleepy. One of the small complications of receiving red cell or platelet transfusions is that, in some patients, your immune system may get sensitised and produce antibodies to so-called ‘minor’ blood groups and other proteins in the blood. This sometimes means that they need carefully selected blood that may need to be specially ordered from NHSBT. Without these precautions, the presence of antibodies would mean the positive effects of a blood transfusion are short-lived. The chances of getting a bacterial or viral infection from a blood transfusion product are exceedingly small with the current NHSBT practises. It is a very elaborate donor selection and screening programme, and it’s improving every year. NHSBT have one of the most robust screening programmes among transfusion services anywhere in the world to ensure a safer transfusion practise. Always feel free to discuss any concerns you might have with your medical team. With thanks to King's College Hospital Haematology Team, London and St James's Hospital Haematology Team, Leeds for their help in developing and reviewing this leaflet You can order this information as a printed booklet from our shop, or download it as a pdf here Transfusions Booklet Manage Cookie Preferences