Cancer Tests and Procedures

Transfusions

The most common transfusions replace the red blood cells and platelets the body cannot make. A transfusion is usually needed when your child's hemoglobin (Hgb) or platelet count is low because of chemotherapy or if his disease is affecting the bone marrow.

Red Blood Cell Transfusions (RBC)

RBCs are given intravenously through an intravenous needle (IV), a central venous catheter (C-line) or a medi-port. Once begun, the transfusion may take two to four hours. Your child's temperature, pulse, respirations and blood pressure will be taken frequently during this time to assess for a transfusion reaction.

Platelet Transfusions

A platelet transfusion generally lasts about one hour. Platelets are transfused intravenously through an IV, C-line, or medi-port.

Transfusion Reactions

Sometimes patients have a reaction to the blood product they are receiving. Some of the symptoms include hives, itching, chills and fever. Rarely, more serious problems such as difficulty breathing may occur. Contact your nurse if you think your child has any of these symptoms during or after a transfusion. In the past, some transfusion reactions were due to white blood cells which are trapped within the RBC or platelet products. Now, the use of special filters usually eliminates white cells and reduces the incidence of these reactions. If your child has a reaction to a transfusion, he will be given Tylenol" and/or Benadryl" prior to the next transfusion.

Preparing Your Child

If your child does not have a central line or mediport, an IV will be started for the transfusion. The IV insertion can hurt. EMLA" cream is sometimes applied to the skin to numb the area before the needle is inserted. The transfusion itself does not hurt; however, the cold temperature of blood going into a warm arm can be uncomfortable. If that happens, a warm washcloth on the arm will help.

Transfusion Safety

Many people have questions about safety when they need a blood transfusion. Some people wonder if the patient could get AIDS or hepatitis from someone else's blood. While this could happen, the risks are low. The blood bank performs routine testing to make sure the blood supply is safe before it is used. Since screening tests were started in May 1985, it is extremely rare for anyone to get AIDS from a transfusion. Blood donated by friends and family is known as directed donor transfusions. Some parents wonder if this type blood transfusion would be safer for their child. This is not necessarily true.

All blood donations are tested the same way. Large studies have been done comparing the safety of blood from directed donors and volunteer blood donors. Blood from volunteer donors was found to be safer than blood from directed donors. Sometimes family or friends may feel pressured to be a directed donors, and would not feel free to admit their blood may be unsafe to use. You can receive directed donor blood information from the physician. Directed donor blood processing takes approximately three days to arrange including testing of the blood before it can be used.

You may note "CMV negative" or "EMV safe" on a blood bag. This label means that a test has been done to see if the cytomegalovirus virus is present in the blood. Cytomegalovirus is a virus that can be transmitted by blood products. However this is a common "cold" virus that most people get by the time they are adults. Certain individuals whose immune system is severely suppressed may develop disease from CMV. Therefore, if a blood test shows that your child has not previously been exposed to CMV your doctor may order "CMV-negative" "EMV safe" blood products.

You may also notice on the blood bag label that the blood has been irradiated. This does not mean that the blood is radioactive. Irradiation inactivates a type of white blood cell known as T-cells in the blood product. T-cells can cause graft-versus-host-disease (GVHD), a reaction of the donor T-cells against the tissues of the person who received them. A child whose immune system is suppressed is at risk to get GVHD from transfusions. We do everything possible to make blood transfusions safe including irradiating it when necessary. If you have any questions, please feel free to ask your child's physician.