Blood transfusion and HD?

[Des]

How often do you get a blood transfusion? ( HD people)... because I have just heard that EVERYTIME you get a transfusion you build up resistance against a WHOLE section of the population and it makes a match for a transplant more difficult.   

I also heard that you do need to get a transfusion regularly as your blood gets "destroyed" faster because it leaves your body??? I know this sounds far fetched but is it true.

Corrected title spelling, Rerun, Moderator

[Rerun]

Not true.

Before the drug Epogen was released to the public in the 1990's anemia was very common in dialysis patients.  This is because normal healthy kidneys produce a hormone called Erythropoietin which tells your bone marrow to produce red blood cells.  When your kidneys no longer work, then you become anemic and need a blood transfusion.  But, since Epogen was discovered we get that most every dialysis session (depending on Hematocrit) in our lines.

So if someone is telling you, you have to have a blood transfusion ask if Epogen would work first.

Avoid blood transfusions.  It will increase your antigens and decrease your matching for a transplant.

If you are predialysis ask for a shot called Procrit (same as Epogen).  It hurts like hell but it is worth it.

[KICKSTART]

I have had 3 blood transfusions now but that was while i was on PD . The trouble was i needed iron and epo while on PD but my BP was too high for epo and it used to take up to 6 weeks for them to arrange IV iron. Now im on Hemo im getting my epo and iron every week to build my hemoglobin back up and its working pretty well. All i know is they told me they prefer if you havent had any transfusions for a transplant , but not why.

[Goofy]

You really need to be careful with blood transfusions. 

That's exactly why I may never get a transplant.  I've had several blood transfusions and also a failed transplant.  Because of both of those issues, I am now considered "highly sensitized".  Right now I am 100% sensitized so therefore I would reject 100% of the population. 

I recently went to Cedars-Sinai in Los Angeles, CA to find out about their "desensitization program".  At this time I'm choosing not to participate.  It involves too may drugs and there are horrible side effects.  And eventually the antibodies come back and there is no guarantee that they can even get rid of enough of them to help.  There is more to it then that but its too detailed to get into it right now.

[Restorer]

I've been very anemic at times (down to less than 7 hemoglobin - less than half what it should be), and because I look like a good candidate for a transplant, my doctors have tried very hard to avoid giving me any transfusions. I've been on Procrit/Epogen since I was diagnosed, as well as iron infusions, and I've never had a transfusion.

[MomInDialysis]

My Mom has been on for over a year now and has never had to have a transfussion.  She has the Epo every session and when her count gets low, they give her iron.  No transfussions yet.

[Des]

This is so cool!

Well now I know.

Just ask and you get an answer.

Thanks   

[KICKSTART]

I've been very anemic at times (down to less than 7 hemoglobin - less than half what it should be), and because I look like a good candidate for a transplant, my doctors have tried very hard to avoid giving me any transfusions. I've been on Procrit/Epogen since I was diagnosed, as well as iron infusions, and I've never had a transfusion.

I went down to 6. !!!! No one even consulted me over a transfusion ( i admit i needed it) but to be asked would have been nice.

[Des]

They are sometimes really acting like idiots.... I think you would have felt better much faster.

[Goofy]

I sure wish I knew about blood transfusions before I had one.  A few years back before I my kidney failure was really declining, I was rushed to the hospital because I couldn't breath or even sit up.  It ened up I had a bleeding stomach ulcer and I had to have a blood transfusion.  No one had ever mentioned to me to try and avoid them so obviously I didn't refuse. The doctors in the ER knew I had PKD.

After the first transusion, the doc came in and asked the nurses if the the blood was filtered and they said no.  He got really angry at them and told me to never accept blood that was not filterd.  That was my first experience to find out about transfusion.

[RightSide]

The only time I ever got a blood transfusion was when I was first diagnosed with ESRD in 2008.  I was so anemic (hemoglobin 7.4) that my neph and I figured it would take too long to build up my blood through meds.  Those two units of blood got my hemoglobin up to around 10.0 within a day.

Now I take Aranesp IV to create red blood cells, and Venofer IV for iron.  The techs just shove these right into the dialysate line while I'm dialyzing.  And it has kept my blood count within a normal range ever since.

Aranesp, Procrit, and Epogen are modern meds.  One or two of the nurses at my dialysis center can still remember when they gave dialysis patients monthly transfusions during dialysis.

[Des]

All these posts just proof that getting transfusions can stuff up your chances for a transplant in the future.

This was a real shocker to me and I think it is something that we as transplant candidates must be aware of before we receive a blood transfusion.

I will now make sure that only as a "last resort" will I allow a transfusion in future.
Thanks

[Jie]

If one has to have blood transfusion, the white blood cells of the blood have to be filtered out before transfusion to prevent the increase of PRA levels. Without the filtering, the PRA level would increase and thus create problems with cross tests for transplant. A positive cross test would have high risks of transplant rejection.
 

[Goofy]

Des, I'm so glad your brought this subject up.  There may be a lot of people out there like me, that didn't know the consequences of blood transfusions.

I never really get angry when I look back and think how my chances of getting a transplant are now pretty slim because of the transfusions.  If anything, my husband is still bitter about it.  There is nothing we can do so I just need to move on. 

[kristina]

Does that mean that each blood transfusion which one has, interferes with the “make-up” of one's own blood type, therefore making it difficult for our body to accept a donor kidney?

Is this what is meant by "sensitivity" to a  donor kidney?

Further to this, my question is, having had 2 blood transfusions in 1981 (two big operations), several more blood transfusions with smaller operations, the very last one in 1987 (big operation),
would my blood today still be considered as “highly sensitized” towards a kidney transplant?

Or, over time, does the blood “regenerate” itself back to the fundamental blood "make-up" we were born with?

(I hope this does not sound confused but I am not medical and I just try to understand this complicated topic).

Thank you.

[Goofy]

Yes, transfusions can mess up your chance for a transplant.  I just posted information from Cedars-Sinai hospital in LA, CA in the "Highly Sensitized" post I started.  I can't really give you any of the answers to your questions but if you do some research or ask your doctor, you can get more information that way.

I'm kind of surprised and not kind of surprised that not everyone doesn't know about sensitization.  I never even heard of it unit I found out I was.  It was a big shock to me.  With something so important, you'd think that would be one of the first things the docs tell you.

Although there are times you have no choice.  I had a friend who has PKD and they told her she needed a transfusion because her hemoglobin was so low but she refused.  In the end, she was able to get her hemoglobin up without the transfusion.  These are things everyone's doctors should tell their patients. 

[Des]

When you recieve any foreign body (blood, transplant or even bacteria) your body builds up a "protection" against that foreign body. That is how it fights against flue and other diseases. That is why you need to take anti rejection drugs after a transplant (mostly) for ever. To prevent your body from "fighting" against the kidney.

After every transfusion or transplant your body builds up resistance against it, thus when they test to see if you are a match they literally mix your blood and the blood of the donor in a test tube and they check after a period of time if your blood attacked the donor's blood or virsa versa. That is how they know that you have built up resistance against that type or group of blood. If they keep on testing and you fight all the peoples blood then you have a
problem to finding a donor that "matches".   
 Your body cannot forget to fight against that foreign body ever without taking alot of medication. But this procedure is in the testing stages only.

This is why some people find there first transplant kidney quicker than the second or third one.


I hope this explains it.

[kristina]

Thank you very much for your time in replying.
It was very kind of you and I appreciate it very much
because now I better understand this complicated matter.
I wish you all the best of luck,
kind regards and thanks again, Kristina.

[Des]

Pleasure.... 

[*kana*]

I refuse all blood unless I am going to die then a there without it.  I had surgery and my level dropped from 13 to 6.5 and they kept insisting that I needed a transfusion.  My entire recovery was made much much worse but as long as I was still alive I wasn't going to get a transfusion and ruin my chance for a successful transplant.  It took me about 8-10 weeks to build back up with Epo.   

[MomInDialysis]

So are you saying all transfusions should be filtered, even prior to knowlege of kidney disease or possible transplant needs in the future.  This all is so interesting.  I do not have kidney disease (YET), and I don't think I have had a transfusion in the past, but I now know that box will be checked with "Ask Patient First".  Thank you for the info.  WOW!

[Jie]

I did not suggest that all blood needs to be filtered before transfusion for all patients. For patients who want transplant in the future, filtered blood would reduce the increase of PRA levels. So, the filtered blood is for potential transplant patients. Of course, it is better to avoid blood transfusion, if possible. But if you need it, filtered blood would be the next better option for potential transplant patients.