Blood Transfusion

Can a hemotologic shock be caused primarily by only the blood not matching or what other ways? Can hemotologic shock cause immediate cardiac arrest? My daughter was having pain in her legs which may have been blood clots forming she then received a blood transfusion and immediately went into shock.

 

Hemolytic blood transfusions due to mismatched blood can progress relatively rapidly (within minutes to hours) with back pain, fevers, and low blood pressure (hypotension).  The hemolysis from a transfusion reaction can lead to a coagulopathy (Disseminated Intravascular Coagulation, DIC) and to renal failure.  This is when you receive the “wrong” unit of blood during a transfusion, usually one whole unit or more.  The Standard of Care in the United States is to infuse the blood slowly initially, check blood pressure and vital signs about 15 minutes after the blood starts and frequently thereafter.  Although you can have a severe reaction, the severity depends on how much blood you received.

 

There are other reasons to develop “shock” when you have sickle cell disease,  are very ill and need a blood transfusion.  You would be informed (or you could find out) if your daughter received a mismatched unit of blood.

 

During a severe pain event you can develop hemolysis related to sickle cell disease and not the blood.  These events are called “hyperhemolysis” and are at least as severe a transfusion reaction.  They are difficult to treat as more blood to correct the anemia from the hyperhemolysis can increase the reaction and make it worse.  It is a very difficult clinical problem.

 

 

I have a two year old granddaughter with sickle cell anemia. She has monthly transfusion.  At the age of of 4 months she had an episode with her spleen and that’s when they started the monthly transfusions.  Why would her physician want her spleen removed?  Is this something that is usually recommended?  I am confused about having this done?

 

A life-threatening splenic sequestration even can happen again if the spleen is not removed, or you can develop hypersplenism leading to a chronically low hemoglobin.  As with many things in medicine you cannot know exactly what is going to happen with every patient.  The issue with severe splenic sequestration is that it occurs rapidly and can be fatal.

 

Transfusions are given to prevent another episode while the child is receiving all of their immunizations.

Most children with hemoglobin SS have functional asplenia by the age of about five years, so having a splenectomy for a child with sickle cell disease is almost (but not the same) as having your spleen lose function.

 

It is recommended that children who have a splenectomy take penicillin for the rest of their lives due to the risk of infection by pneumococcus.

 

You should have all of the recommended immunizations including the 23 valent pneumovax and meningococcal vaccine before an splenectomy.

 

There is risk for everything, but most people think the risk of a second life threatening splenic sequestration warrants surgery.  Of course there are children who have splenic sequestration that is not life threatening (or maybe was) and do not have a splenectomy and do okay.  You have to decide how much risk you are willing to take with your beautiful granddaughter.

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