Do Leukemia Patients Always Need Blood Transfusions?

Leukemia is a cancer of the blood. Blood Cancer UK says it affects the way your body makes blood cells. There are multiple types of leukemia, and most types mainly affect your body’s white blood cells. The white blood cells are the cells your body uses to fight infection.

Most forms of leukemia cause a large amount of cancerous white blood cells to grow. This crowds out healthy white blood cells and makes it impossible for your immune system to fully function. As leukemia progresses, the cancerous white blood cells can also overwhelm your red blood cells and platelets. Too few red blood cells can result in anemia and too few platelets can make it difficult for your blood to clot.

You can also develop anemia from leukemia treatments. Radiation and chemotherapy are used to kill cancer cells. The treatments can also prevent your body from making new healthy blood cells.

Additionally, cancer treatments can make it hard to eat the food you need to get enough iron in your diet. A diet that is too low in iron can lead to anemia and fatigue.

A blood transfusion does not treat leukemia itself or fight cancer. But it does treat the symptoms caused by leukemia’s effects on your blood.

The transfusion you receive will be of blood components taken from donated blood. The donated blood has been filtered and separated. So instead of receiving whole blood, you’ll just receive the component that is most helpful to you.

For example, if you have anemia, you’ll just receive red blood cells. If you’re low in platelets, you can just receive platelets.

Other components you can receive include:

• white cells, or granulocytes
• albumin
• plasma and cryoprecipitate
• gamma globulin

Types of blood transfusions used to treat leukemia

A few types of blood cell transfusion are commonly used to treat leukemia. According to the Leukemia & Lymphoma Society, they include:

• Red blood cell transfusions. These transfusions can treat anemia. They’re prescribed to people with leukemia who have low red blood cell counts and who are starting to experience anemia symptoms.
• Platelet transfusions. Doctors prescribe platelet transfusions to people with leukemia who have low platelet counts. They can treat and lower the risk of excessive bleed and bruising.
• Plasma and cryoprecipitate transfusions. These are sometimes ordered for people who have low levels of proteins that help their blood clot. This generally happens as a result of liver conditions and is less common in leukemia. However, it can occur in people with promyelocytic leukemia.
• Gamma globulin transfusions. Gamma globulins are proteins in blood plasma that help prevent infection. People with chronic lymphocytic leukemia often have low levels of gamma globulins and need a transfusion to replenish their blood.
• Albumin transfusions. These transfusions are less common. People who have liver conditions or whose leukemia has affected their liver might need an infusion of this blood protein.
• Granulocyte transfusions. Doctors sometimes prescribe these to people with low white blood cell counts to lower the risk of infection. They are infrequently performed and are not a routine part of leukemia care. This is due to difficulties in the collection, processing, administration, and potential adverse effects. Granulocytes are a type of white blood cell.

There is no standard or set amount of transfusions that people with leukemia need. Some people with leukemia might never require blood transfusions. Others might need them as frequently as multiple times per month.

It’s more common for people with advanced leukemia to have frequent transfusions. But even at that stage, this doesn’t apply to every person.

Blood transfusions are generally considered safe. Most people receive transfusions without any reactions. However, just like any medical procedure, there are some possible risks. Some reactions are immediate and will occur during or right after the transfusions. Other possible reactions won’t occur until weeks or even months later.

Immediate side effects include:

• fever
• rash
• hives
• nausea
• back pain
• low blood pressure
• shortness of breath
• dark or red urine
• pain at the transfusion site

A fever is the most common side effect of transfusion. Let medical staff know right away if you experience any of these side effects. If needed, they can make changes such as stopping the transfusion early.

Reactions that can develop weeks or months later include:

• Viral infection transmission. There is a slight risk of getting a viral disease from a blood transfusion. However, developments in blood testing have greatly lowered this risk over the past several decades.
• Cytomegalovirus (CMV) transmission. CMV can cause pneumonia and other complications in people who are having stem cell transplants. Doctors are especially cautious about the risk of CMV transmission in people who have had a blood transfusion and who will be having stem cell transplants.
• Bacterial infection transmission. It’s rare to get a bacterial infection from a red blood cell transfusion, but it is possible. However, precautions are taken at blood facilities to make sure this risk remains very low.
• Alloimmunization. Alloimmunization occurs when your immune system makes antigens against the transfused blood. It doesn’t always cause symptoms, but it can make side effects during future blood transfusions more likely.
• Graft-versus-host disease (GVHD). GVHD is a very rare reaction that can occur after a transfusion of white blood cells. In GVHD, the donor white blood cells attack your body’s skin, bone marrow, liver, and bowels, resulting in serious complications.

According to the Canadian Cancer Society, there are very few steps you need to take to prepare for a non-emergency blood transfusion. You can maintain your usual diet and daily activities before your blood transfusion. Most blood transfusions are done in an outpatient clinic. Before your transfusion, it’s a good idea to:

• Ask your doctor how long the transfusion will take. Most transfusions take between 1 and 4 hours.
• Stay well hydrated.
• Pack a book or laptop to keep yourself occupied during the transfusion. You’ll usually be able to work, read, eat, or drink after the first 15 minutes or so of the transfusion as long as it doesn’t interfere with the IV line.
• Pack a water bottle and a light snack.
• Pack a blanket, hoodie, or sweater.

Blood transfusions can be part of leukemia treatment. They don’t fight cancer, but they can help treat low blood counts caused by leukemia and leukemia treatments.

Blood transfusions might be ordered if you’re experiencing anemia, low platelet counts, or low white blood cell counts. Not everyone who has leukemia will need blood transfusions. Blood transfusions are generally considered safe, and serious reactions are rare thanks to improved blood testing in the past 20 years.