Tell me about transfusions

[DeeEast]

Has anyone's DC had one or more? DS is headed back to the hematologist tomorrow and a transfusion is looking more likely. The hematologist said it could be done on an out-patient basis but I have no idea what it entails.

I had posted before about his possible diagnosis of TEC (transient erythoblastopenia of childhood) and today his hemoglobin came back at 4.6. Down from 4.7. The all-time low had been 4.3 (that we know of, at least since he's been tested over the past week and a half).

[blisstwins]

I don't know anything about transfusions, but I can imagine your anxieties so I wanted to let you know I will keep you son in my thoughts and prayers.

[Fairy]

I a transfusion in the hospital after DS was born due to complications and blood loss. I was, of course, an adult, and I have no BTDT for you on a pediatric transfusion. However, I can tell you the process. At a very high level -->

* He will be typed (if he's not already, which is unlikely if you're at the hematologist level)
* At 4.7, I'd imagine he'll have the equivalent of what I had at least, which was two units, which is two bags). I don't know how it works for kids, but I went down to a 7 overnight, and they gave me two bags until I finally came up to almost an 11 and they let me go home). So, at 4.7? I'm thinking he'll need that equivalent plus some? So, in other words, expect a bit of volume.

* They will go thru a big to-do of showing you the label on the bag, what the blood type is and that it's been tested negative for HIV and other communicable diseases. They take this very seriously. You'll have a bit of paperwork here. Well, I did, anyway.

* They will prepare an IV for DS, which is how the units are transferred. They may send a preparation solution into him first; not sure what this is, but it's what I had. Saline or something. I jsut don't remember anymore!

* Then the unit will go in. It took me five or seven hours for all of the two bags to go in. The actual plan was one bag, but after it was done, they poked me a bit, and chose to do another one, and we went thru the process all over again except for re-iV'ing me. So, I really had two transfusions technically, I guess. But it's a long time for the drip.

* I was then on Iron for six weeks and had to be re-tested.

This was my routine to the best of my recollection, tho to be fair, it was five years ago, and I literally went from fine to very sick overnight and barely remember those two really not fine days. But this is what I remember about the transfusion.

I really wish DS the very best and sending you P & PT.

-- Fairy

[DeeEast]

I don't know anything about transfusions, but I can imagine your anxieties so I wanted to let you know I will keep you son in my thoughts and prayers.

Thank you very much. That was very informative. The hematologist said that he would have to be typed and crossed again tomorrow, even though they did it already, because that only lasts 72 hours. ?

He also said that it could possibly be done on an out-patient basis, but based upon what you said I am thinking that we will be spending the night at least.

One more thing, I assume as an adult that you were awake for the entire thing, and am wondering if anyone knows if a 4 year old would be sedated for the procedure? He did have an IV for the days that we were in Children's but I wonder if they sedate pediatric patients for transfusions?

[Fairy]

I assume you meant to quote me? :)

For me, they did it late at night, and I fell asleep. I am a heavy sleeper and didn't really wake up every time they came in to check on me, (which was alot; more than hourly). but I did wake up three or four times in that 7 hour period cuz the IV had to be flushed (I think) and when they had to load a 2nd bag (and I had to re-confirm the bag label and I *think* sign more papers) and with taking my vitals a time or two. But I was really sick and when you're that anemic, I think sleep comes easy. I would see what you can do to have this done overnight so that he can sleep. Not sure how old he is, but if he's a toddler or older, load up the DVD player with enough shows to last 8 hours. Sesame, Cars, Peter Pan, etc., assuming he's not going to be sleeping. If these are not good solutions for you, then perhaps sedation is not a bad idea. Personally, I would probably opt for that.

I'm so sorry. Let me know if you have any other questions, I'm happy to help.

[DeeEast]

I assume you meant to quote me? :)

For me, they did it late at night, and I fell asleep. I am a heavy sleeper and didn't really wake up every time they came in to check on me, (which was alot; more than hourly). but I did wake up three or four times in that 7 hour period cuz the IV had to be flushed (I think) and when they had to load a 2nd bag (and I had to re-confirm the bag label and I *think* sign more papers) and with taking my vitals a time or two. But I was really sick and when you're that anemic, I think sleep comes easy. I would see what you can do to have this done overnight so that he can sleep. Not sure how old he is, but if he's a toddler or older, load up the DVD player with enough shows to last 8 hours. Sesame, Cars, Peter Pan, etc., assuming he's not going to be sleeping. If these are not good solutions for you, then perhaps sedation is not a bad idea. Personally, I would probably opt for that.

I'm so sorry. Let me know if you have any other questions, I'm happy to help.

Yes, I meant to quote you. I'll claim extreme stress for my mush-mind. Thanks for the info. We meet with the hematologist tomorrow and if its a possibility that they can do it overnight while he sleeps, that may be a good option. He's 4 and is as the point now where he hates needles and the IV is especially traumatic, since he just had one.

[DeeEast]

I don't know anything about transfusions, but I can imagine your anxieties so I wanted to let you know I will keep you son in my thoughts and prayers.

Thanks so much.

[DeeEast]

One more question: What to expect for after-care? Is there any special concern for infections and injury? As in not taking him to public places? We've been doing that already but DH and I are not in the same mind-set about it so I am left thinking that I may be over-protective.

[Fairy]

Yes, I meant to quote you. I'll claim extreme stress for my mush-mind. Thanks for the info. We meet with the hematologist tomorrow and if its a possibility that they can do it overnight while he sleeps, that may be a good option. He's 4 and is as the point now where he hates needles and the IV is especially traumatic, since he just had one.

I think your extreme stress is warranted. I know you'll have alot of emotional support here, albeit of the online variety. Your poor little dude and the needles. If there's anything more I can do to help with info or my experience, don't hesitate to ask or PM me. Keep us updated. :hug:

[caheinz]

I had to get several units after my twins were born...

One thing that wasn't mentioned yet is that they insisted on giving Benedryl to ward off adverse reactions. It certainly knocked me out...

I think they did 3 units in 6ish hours. (I was groggy enough that it'd be hard to say.)

I didn't have any specific post-op instructions. But, I had just had a c-section to birth twins, so I think those post-op instructions trumped everything else.

[SheriRae]

My son has had a good number of transfusions...first one was when he was 1 1/2 years old.

Our out-patient transfusion were always done at the pediatric hematologist/oncologist office. If your son is having his transfusion at the office there will mostly likely be toys, movies, etc to help keep him occupied. My experience is at the hematology/onc office is that there will be other children receiving transfusions and or chemotherapy at the same time. There is usually individual rooms for you to use or a "great room" which families and kids can sit together. There will be tv, toys, etc to keep kids busy here. They deal with this everyday and are very prepared to help keep kids busy. Depending on the size of the office there may be a Child Life Specialist that interacts with the kids to help keep them busy. To be honest, I prefer the out-patient.

My son was never sedated even at a very young age. With counts as low as 4.6 your son will probably sleep or watch a movie through his transfusion. He will be mobile with your help by pushing the IV pole. My son's last transfusion was 2 hours (per unit of blood) from the time the blood was hung to finish.

My son usually felt much better by the next day after receiving blood. Energy level comes back rather quickly.

I'm not familiar with your son's condition but my son's aftercare was basically whatever he could handle. No restrictions.

Good luck. The most difficult thing will be the poking of needles. Keep reminding him this is all to help him feel better.