In the modern medical world when you are getting a blood transfusion, it is typically only a specific component of the blood (red blood cells, white blood cells, plasma, clotting factors, or platelets) instead of whole blood. Over the course of my treatment so far, I’ve been receiving both platelets (frequently) and RBCs. To track my counts, I have labs done every other day, so when/if my levels are too low, then I get a transfusion. Since I’m not in an inpatient setting where the medical staff can more closely monitor my levels, my criteria for requiring transfusions doesn’t let me drop to dangerous levels. My criteria for transfusions are that if my Hemoglobin (Hgb) is at or below 8.0g/dL, I’ll need RBCs, and if my platelets are at 20 (10e3/uL) or below, I’ll need to get platelets. Pretty straight forward. For reference of standard ranges, Hemoglobin should be between 11.2-15.7 and platelets between 163-369 10e3/uL.
When the medical team gets my blood results back and see that I need a transfusion, they place an order for the platelets or RBCs and the processing begins. If we’re lucky and it’s available in the hospital’s blood supply, it won’t be too long of a wait, but if they have to order it from the blood bank downtown, it typically takes a while longer.
Before donor blood can be given, they test it to make sure it matches up with your blood, just as a confirmation of the blood typing of both parties. Then the donor blood is filtered and irradiation, as a precaution to graft-versus-host-disease and removal of any lingering antibodies. Because of my immunosuppressed state, the blood I receive is also tested for Cytomegavirus (CMV) and must be CMV-negative.
As a precaution and because of a previous platelet reaction, I receive premeds before the start of my transfusions to help prevent an allergic reaction, typically consisting of acetaminophen and diphenhyramine. If I’m to receive platelets, they may also give me an IV steroid, if there is concern that I may have an anaphylactic response. Having a Hickman catheter or a PICC line makes the transfusion so much easier. The nurse only has to connect the IV to one of my ports and away we go! My vitals will be taken before we get started and then often throughout the transfusion to make sure nothing spikes/drops and that I’m not experiencing any adverse symptoms.
While a blood transfusion can take a while (about 1.5-2 hrs/unit), platelets can go in pretty quickly, as little as 15 minutes, as there is much less volume to take in. Despite quicker transfusing, platelets are also more likely to cause an immune response as mild as chills or as extreme as anaphylaxis. While a full-fledged allergic response is not typical, it can occur when getting more frequent transfusions. And once you experience it, you certainly never want to experience it again...hence the necessity of premeds and making sure to notify the nurses of any funny sensations. Remember, don’t be a hero!
Can you tell when you’ll be needing blood products?
Before getting my transfusion, regardless of the labs, I usually know when my hemoglobin or platelets are getting low. When my platelets are getting low my bruising gets worse, I start to have more random blood vessel spotting (like on my tongue), and I bleed more easily with poor clotting. On the other hand if my red blood cells are low, I tend to get lightheaded and dizzy more easily, feel more tired overall, and have a faster, more pronounced heartbeat. Neither situation feels particularly good.
What does it feel like to get a transfusion?
I notice that when I get RBCs, it’s very easy to tell it if it’s going too quickly. I start to feel chest pain and it begins to get hard to breath. So speed for me, whether for red blood cells or platelets (especially), is really an important factor of how well my transfusion goes. I like to remind myself that slow and steady wins the battle against allergic reactions and to just think of the process as a marathon instead of sprint. For example, I had a marathon RBC transfusion on Wednesday (6.5 hours!), as a result of reducing the transfusion speed. Whether getting platelets or RBCs, I find that I do feel the fluid coming into my body and that my hands tend to get tingly but that the more frequently I've gotten transfused, the more used to the sensations I've become.
How do you feel post-transfusion?
I typically feel better after getting a transfusion but find that it takes my body a while to adjust to the change and about 24hrs for my body to adapt to the large fluid intake of RBCs. While I may feel energized after getting platelets, if I overdo it with activity afterwards, I’ll end up tired the following day. So if nothing else, I’ve learned that it’s a fine balance in watching my energy levels.