Why doesn't my mother's doctor want to perform a red blood cell transfusion, just because she's never had one before?

1 answer | Last updated: Dec 05, 2016
A fellow caregiver asked...

My mother is undergoing chemotherapy for metastatic lung cancer, and her red blood count is low. Her doctor doesn’t want to perform a transfusion unless absolutely necessary, because he says it’s riskier the first time. Why would the first time be riskier?

Expert Answers

Andrew Putnam, M.D. is a Palliative Care physician at Smilow Cancer Center at Yale New Haven Hospital and Yale University.

When your mother’s red blood count (RBC) is low, her doctors may start considering a transfusion if her anemia is causing symptoms such as extreme fatigue and shortness of breath. Unlike a platelet transfusion, a transfusion of red blood cells can have both immediate and long-lasting benefits, since the average red blood cell lives 120 days. But if your mother has never had a transfusion before, then there’s a risk involved because her doctors don’t know whether she can tolerate the transfusion without having a reaction. So they prefer to hold off on that first transfusion and will wait as long as they can to see if the RBC will come up on its own.

Reactions to a transfusion can range from a mild allergic reaction (such as hives or itching) to a moderate reaction (usually involving fever) to a severe reaction (which is rare but can be fatal). With someone who’s already had a transfusion with no problem, doctors will feel more confident and will move more quickly.

Another thing to realize is that there’s no hard-and-fast number that doctors can use to determine when to do a transfusion, since one person might feel fine with a very low count while another person feels worse despite a higher count. So doctors try not to treat to a number but make situation-specific decisions. Your mother’s doctor will try to evaluate how bad her symptoms are and whether there are other steps she can take that will help.

The doctor will also take into account other health problems your mother might have, such as whether she’s ever had a heart attack or stroke. When there’s low oxygen in the blood, it can kill off heart muscle. So if your mother has had heart problems, doctors will be more likely to transfuse sooner, before her red blood count falls too low, to protect her heart. !