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.