why not red blood cells transfusion?

[neurontin]

Could you please tell me why a patient does not have RBC transfusion? She is a 22-year-old female with 13 months pregnancy. She has sickle cell crisis. Her physician ordered many opioids (low dosages) for her pain. My question is why not transfuse RBCs to her?

Thanks!

[JennNJ83]

Usually a patient in sickle cell crisis they will infuse fluids, put them on O2 and give pain meds. Red blood cells won't help, the problem is the occlusion of the vascular spaces caused by the sickling. What do you mean by 13 months pregnancy?

[ckh23, BSN, RN]

Just because she is sickle cell doesn't mean she needs a transfusion, especially if she isn't anemic. Treatment might just be supportive until the crisis passes. A transfusion will not solve the problem, but o2, fluids, and pain meds will help.

[merlee]

We are not allowed to give medical advice here, and I think your information is very strange. If you have a question, ask her doctor.

[sharpeimom]

could the op have meant weeks and accidentally typed months instead?

[ckh23, BSN, RN]

We are not allowed to give medical advice here, and I think your information is very strange. If you have a question, ask her doctor.

The OP is not asking for medical advice, she is simply asking the question of why the patient wouldn't get a blood transfusion.

[caroladybelle, BSN, RN]

Several reasons:

First SCC is generally brought on by dehydration. When the pt with SC is well hydrated, the sickled cells travel easily through the blood stream. When the pt gets even mildly dehydrated, the blood thickens and moves more sluggishly, and the sickled cells get "caught" causing pain as well as O2 deprivation to tissues, resulting in pain. Thus treatment is to rehydrate, allwing the blood to move better, give O2 to aid in oxygenation of tissues, and pain meds to treat symptoms until recovery.

PRBCs are just that - packed red cells, with little excess fluid. It, too, is quite thick. Putting it in during acute SCC, often just aggravates the problem, adding to the sluggishness, etc. And not really improving oxygenation.

Second, most SCCers are used to operating on low HCT levels, due to their disease. There is less symptomology and they can usually tolerate a low HCT (much like chronic renal failure pts tolerating a higher serum K+).

Third, blood is an increasingly scarce resource, especially some types.

Fourth, blood is not a benign product - it has serious risks of bloodbourne disease, especially with repeated use.

Fifth, most SCCers will receive a large amount of blood products in their lifetime, more so than the average person. Each unit of product exposes the pt to more antibodies/antigens...often over time this may result in the pt getting sensitized. When this occurs, it becomes more and more difficult to find blood that will be safe for transfusion for sensitized individuals. Then, it may take many more hours or days to get blood for someone...a potentially dangerous situation when they absolutely need blood quickly

Thus, we have to be a bit more careful and reserved in pts that we know will have a greater than average need for blood products.

As a note, I work with leukemics, and we have to seriously limit platelet transfusions because of the high rate of sensitization. Often their threshold is 10-20K, unless bleeding.... a very low number.

[juzme]

yeah, I agree Sharpeimom and CKH;-)! And maybe the OP not seeking MA, just has a question, as we all do at times.

[juzme]

Thank you for explaining Caroladybelle. I know, I have learned something:-)

[mskate]

i'd be more worried about a 13 month pregnancy....

[CrufflerJJ, BSN, RN, EMT-P]

Several reasons:

First SCC is generally brought on by dehydration...

PRBCs are just that - packed red cells, with little excess fluid. It, too, is quite thick. ...

Second, most SCCers are used to operating on low HCT levels, due to their disease...

Third, blood is an increasingly scarce resource, especially some types...

Fourth, blood is not a benign product - it has serious risks of bloodbourne disease, especially with repeated use...

Fifth, most SCCers will receive a large amount of blood products in their lifetime...

Excellent post...thank you!

[OutlawNurse86, BSN, RN]

13 months? I'd be more concerned as to why they ain't induced her yet...