“How do you know when you need a blood transfusion?”
My mother is anemic, pale and weak. The doctor said her hemoglobin and other blood work isn't low enough for a blood transfusion. Is there a certain value of when they give one or is it specific for each person?
1 Answer
This is a touchy subject. Simply put, blood transfusions are typically given more frequently than they should be and we are currently trying to turn this around in medical practices around the nation. With that being said there may sometimes be over emphasis on not transfusing patients. You can ask ten doctors and get multiple preferences in regards to when to transfuse a patient but this is a rough guideline that I like to use. #1: Transfuse for hemoglobin less that 7.0. There are some patients with chronic anemia in the setting of cancer treatments that may be asymtomatic even when less than 7.0 and could have a lower threshold for transfusion. #2: Transfuse for acute blood loss causing symptoms (dizziness, weakness, palpitations) even with hemoglobin above 7. #3: Transfuse for patients with coronary artery disease for Hemoglobin <8.0-9.0 depending on circumstances. Transfusion typically won't improve mortality in most other situations and is not risk free. Patients with chronic anemia can benefit by treating the cause of their anemia be it vitamin deficiency, iron deficiency, or blood loss. Often times patients with advanced kidney disease require replacement of the enzyme which stimulates the bone marrow to make red blood cells called erythropoetin. A nephrologist will typically give these patients epogen and intravenous iron replacement therapy to achieve a goal hemoglobin >10.0. This treatment may cause increased mortality if given to a patient with hemoglobin >11. There is another group of patients with anemia of chronic disease which deprives the body of iron by storing it in the liver and requires treatment of the underlining chronic medical issues. There are obviously many more circumstances to consider but these are the most frequent things to consider.
To answer your question more specifically, I would assess how much improvement your mother has following a transfusion, specifically in her energy levels and consider therapeutic transfusions only if her underlining cause of anemia can be corrected. If her underlining cause of anemia is unable to be corrected I think it is an indication that your mother may be chronically ill and her body is simply not able to function sufficiently anymore. Typically these patients will have other indicators such as loss of appetite, trouble swallowing, weight loss and even multigrain dysfunction.
My heart goes out to you, I know it is frustrating to see a loved one in such circumstances.
Sincerely,
Jack Stephens, MD
To answer your question more specifically, I would assess how much improvement your mother has following a transfusion, specifically in her energy levels and consider therapeutic transfusions only if her underlining cause of anemia can be corrected. If her underlining cause of anemia is unable to be corrected I think it is an indication that your mother may be chronically ill and her body is simply not able to function sufficiently anymore. Typically these patients will have other indicators such as loss of appetite, trouble swallowing, weight loss and even multigrain dysfunction.
My heart goes out to you, I know it is frustrating to see a loved one in such circumstances.
Sincerely,
Jack Stephens, MD
