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DO'S AND DON'TS

Blood transfusion in Thalassaemia

Prof Dr Manzur Morshed
Thalassaemia is a genetic disorder that affects haemoglobin (the oxygen-carrying protein in red blood cells) by early destruction. To keep the patient fit and maintain adequate amount of haemoglibin, regular blood transfusion is considered to be essential. In many cases, blood transfusion is started soon after birth and is continued indefinitely.
For all these, it is very important for doctors as well as patients or their guardian to know right decision making about blood transfusion. It must be remembered that it should not be taken lightly as transfusion may cause more harm than the disease itself if the judgment is inappropriate.
A common misconception is that the decision to transfuse blood depends on certain level of haemoglobin (Hb). If one
person has a haemoglobin level below 7 or 8 gms, s/he is considered to be a candidate for blood transfusion. This is not correct. The fact is that, for a thalassaemia patient, blood transfusion decision is taken after careful consideration of several factors. It includes growth velocity, appetite, spleen size and quality of life in addition to Hb level. For this reason, one may receive transfusion, while his or her Hb level is 6 gms per cent, while another patient with same Hb level may not require blood transfusion. There are several studies in neighboring countries including Sri Lanka where it has been shown that certain thalassaemia patients are able to adjust with a level of Hb that is not considered adequate for other people including thalassaemics.
Since blood transfusion is a potentially harmful therapy; every attempt should be made
to avoid transfusion whenever possible. Safety of blood is another issue that needs careful consideration. Though in blood banks, blood is tested for harmful organisms before transfusion, blood cannot be declared 100% safe as these tests are not foolproof.
Because of repeated transfusions, many thalassaemia patients develop allergy and intolerance to further blood transfusion. To avoid reactions and fever, a kind of blood filter (called leucofilter) has been recommended to be used during transfusion.
Iron accumulation in different organs of the body because of repeated blood transfusion is a well-known side effect. It causes damage to the organs and result in development of diabetes, growth failure, bone damage, liver failure and heart dysfunction and failure.
For all the reasons above,
blood transfusion should be decided on careful considerations of many factors, not only on the Hb level alone. Before transfusion, the question that should always be answered is — do the benefits of blood transfu-
sion significantly outweigh all the potential harms?
The writer is Consultant Hematologist, Square Hospital and also an Advisor of Bangladesh Thalassemia Foundation. E-mail: manzur.morshed@gmail.com