Blood transfusion for hemodialysis patients

[jo]

My mom's hemoglobin is 6.8 and the dialysis nurse is asking us to go to the ER to get a blood transfusion. We are a little hesitant if we should just wait instead for her hgb to rise because of possible infections that could happen during a transfusion. Is it safe for hemodialysis patients to get a blood transfusion? The nurse asked us to go to the ER if my mom experiences any symptoms of low hgb. She doesn't have any symptoms as of today, but we are planning to take her to the ER anyways tomorrow after dialysis. Is it possible to do a blood transfusion during dialysis or would it be best to do the transfusion at the ER? Please let me know your suggestions/recommendations.

And, what could be the cause of her low blood levels? She is being treated with antibiotics for a staph infection in her blood and the medical team did several blood cultures during her stay in the hospital. I am thinking continuous blood draws has dropped her hgb levels. Would hgb drop due to continuous blood draws or is this something that needs to be evaluated? Thanks everyone for reading this.

[Charlie B53]

While it is possible for blood loss to lower values it usually has to a significant amount of blood loss, rather unlikely for lab draws to be the primary cause but still possible in a very small person.

Depending on the severity, transfusion may be the quickest method to bring up her values. 

Potential drawbacks need to be discussed with her Dr's.   If no symptoms she may elect for other medication to assist her body in producing the values, but this does take time.   What are the risks of waiting for medication to work?   Is another question she needs to ask her Dr's in order to make a better informed decision.

[justagirl2325]

My husband's also dropped to that level as well.  It was post surgery so they worried for a bit about internal bleeding but then determined that wasn't happening.  In the end no one could say for sure why it dropped so low.  He received two transfusions at two different hospitals and they both did it during dialysis.  He seems much better now (can stay awake longer, more energy). 

[Simon Dog]

My mom's hemoglobin is 6.8 and the dialysis nurse is asking us to go to the ER to get a blood transfusion. We are a little hesitant if we should just wait instead for her hgb to rise because of possible infections that could happen during a transfusion. Is it safe for hemodialysis patients to get a blood transfusion? T

Transfusions have an additional "cost" to anyone considering a renal transplant.

Read up on alloimmunization.   It's the reason transfusions can increase the PRA for a transplant candidate, and also why "transfusion history" is a part of the medical writeup on a transplant patient or candidate.

I dipped down to 6.2 after my hip replacement surgery.    I chased away residents who were ordering a transfusion to be given with dialysis in the hospital.  At one point, a fellow who was ordering a transfusion had to be talked out of it by the chief of hematology at the hospital.   Surprisingly, this was on a dedicated renal floor where the MDs should have known better.   I've even met MDs who have never heard of this particular issue.

It took about 6 weeks post surgery for me to get back up to 10, and I was sentenced to clinic treatments until I hit 8.5.  At one point, I was taking 50,000 units of EPO per week.

I finally got back to a  "normal" 10-11 HGB, with no transfusions or complications.

Blood draws can lower HGB if there are enough of them.  I was told I lost about .2 HGB from the blood draws when I was in for 17 days - morning labs every day, and at least three cultures (which consist of two small bottles, not tubes, of blood)

[jo]

My mom's hemoglobin is 6.8 and the dialysis nurse is asking us to go to the ER to get a blood transfusion. We are a little hesitant if we should just wait instead for her hgb to rise because of possible infections that could happen during a transfusion. Is it safe for hemodialysis patients to get a blood transfusion? T

Transfusions have an additional "cost" to anyone considering a renal transplant.

Read up on alloimmunization.   It's the reason transfusions can increase the PRA for a transplant candidate, and also why "transfusion history" is a part of the medical writeup on a transplant patient or candidate.

I dipped down to 6.2 after my hip replacement surgery.    I chased away residents who were ordering a transfusion to be given with dialysis in the hospital.  At one point, a fellow who was ordering a transfusion had to be talked out of it by the chief of hematology at the hospital.   Surprisingly, this was on a dedicated renal floor where the MDs should have known better.   I've even met MDs who have never heard of this particular issue.

It took about 6 weeks post surgery for me to get back up to 10, and I was sentenced to clinic treatments until I hit 8.5.  At one point, I was taking 50,000 units of EPO per week.

I finally got back to a  "normal" 10-11 HGB, with no transfusions or complications.

Blood draws can lower HGB if there are enough of them.  I was told I lost about .2 HGB from the blood draws when I was in for 17 days - morning labs every day, and at least three cultures (which consist of two small bottles, not tubes, of blood)

She had about 7 blood cultures along with morning labs every day. Her hgb was around 8.6 on 09/29/16 but dropped to 6.8 within a week so I suspected the frequent blood draws as the cause of low hgb levels. We don't want her to get a blood transfusion because of the problems associated with it. Should we request her neph to put her on Arnesp frequently until her levels go up? She usually gets Arnesp once a week and IV iron infusion every other month at the dialysis clinic.

[jo]

My mom's hemoglobin is 6.8 and the dialysis nurse is asking us to go to the ER to get a blood transfusion. We are a little hesitant if we should just wait instead for her hgb to rise because of possible infections that could happen during a transfusion. Is it safe for hemodialysis patients to get a blood transfusion? T

Transfusions have an additional "cost" to anyone considering a renal transplant.

Read up on alloimmunization.   It's the reason transfusions can increase the PRA for a transplant candidate, and also why "transfusion history" is a part of the medical writeup on a transplant patient or candidate.

I dipped down to 6.2 after my hip replacement surgery.    I chased away residents who were ordering a transfusion to be given with dialysis in the hospital.  At one point, a fellow who was ordering a transfusion had to be talked out of it by the chief of hematology at the hospital.   Surprisingly, this was on a dedicated renal floor where the MDs should have known better.   I've even met MDs who have never heard of this particular issue.

It took about 6 weeks post surgery for me to get back up to 10, and I was sentenced to clinic treatments until I hit 8.5.  At one point, I was taking 50,000 units of EPO per week.

I finally got back to a  "normal" 10-11 HGB, with no transfusions or complications.

Blood draws can lower HGB if there are enough of them.  I was told I lost about .2 HGB from the blood draws when I was in for 17 days - morning labs every day, and at least three cultures (which consist of two small bottles, not tubes, of blood)

She had about 7 blood cultures along with morning labs every day. Her hgb was around 8.6 on 09/29/16 but dropped to 6.8 within a week so I suspected the frequent blood draws as the cause of low hgb levels. We don't want her to get a blood transfusion because of the problems associated with it. Should we request her neph to put her on Arnesp frequently until her levels go up? She usually gets Arnesp once a week and IV iron infusion every other month at the dialysis clinic.

[Simon Dog]

Should we request her neph to put her on Arnesp frequently until her levels go up? She usually gets Arnesp once a week and IV iron infusion every other month at the dialysis clinic.

I am not qualified to answer that question, however, I do suggest that you do not accept transfusions except in a life threatenting emergency without a go-ahead from both your neph and the MD at her transplant center (if any).

[jo]

Should we request her neph to put her on Arnesp frequently until her levels go up? She usually gets Arnesp once a week and IV iron infusion every other month at the dialysis clinic.

I am not qualified to answer that question, however, I do suggest that you do not accept transfusions except in a life threatenting emergency without a go-ahead from both your neph and the MD at her transplant center (if any).

Thank you. Question about Aranesp - I am not sure if you know the answer, but are you supposed to get Aranesp along with IV iron infusion?