
5 minute read
My Blood My Health Issue 2
Blood transfusions have saved many lives since their introduction into clinical practice. In 1818, the British obstetrician James Blundell successfully transfused human blood to a patient to treat postpartum hemorrhage. The use of transfusions in the early decades of the twentieth century became safer with the discovery of the major blood groups (the blood alphabet). Today, it is one of the most frequent procedures worldwide
Blood transfusions are essential for patients who experience blood loss They can replace the blood lost during surgery or because of an injury. Some treatment can cause temporary anemia, necessitating blood transfusion for a short period. However, some medical conditions require frequent blood transfusions continuously. These conditions include blood cancers or noncancer blood diseases such as anemia, hemophilia, and sickle cell disease
Challenges associated with transfusion-dependency
Being dependent on transfusions has drastic consequences on patients and their entourage. Frequent transfusions are associated with poor quality of life (QoL) and several complications, some of which can be life-threatening.
A person who requires frequent blood transfusions can quickly develop iron overload The daily iron intake should be between 87 and 148mg, depending on the sex and age. Each blood bag contains around 250 mg of iron. It takes roughly 250 days for the body to eliminate this excess of iron. So, ten transfusions delivered in a short period (5 months) can be enough to develop meaningful iron overload
Untreated iron overload can lead to severe heart and liver problems; for people who need frequent transfusions, a treatment to reduce the iron level in the body (iron chelator) is necessary.
Adding an iron chelator to the treatment regimen for non-cancer blood disorders is part of the clinical practice because these disorders are diagnosed at a young age However, for patients affected by blood cancer, because of their older age, monitoring iron overload and prescribing chelation is not as automatic.


Real-life patient experience with frequent blood transfusions
We surveyed transfusion-dependent people to assess this condition's impact on their lives. The participants were all diagnosed with blood cancer; they were all older than 35 years old.
Survey participants mentioned receiving a blood transfusion every week to every second week for two to five years
Frequent transfusions impacted their and their caregiver's working status Often, they had to precipitate their retirement, reduce their working hours or even go on a disability program. Only 75% of them are receiving treatment for iron overload.
On average, each transfusion takes 65 to 95 hours, including transportation time Some participants need to drive more than four hours to receive their transfusion Also, depending on the patient's hemoglobin level, sometimes patients won't receive it

Real-life patient experience with frequent blood transfusions (con`t)
The main reasons for receiving a transfusion are: fatigue anemia low Hemoglobin (Hg)
Most participants (75%) experienced adverse reactions during the transfusion: fatigue (50%), blood pressure drop (25%) allergic reactions (25%)

Most participants (75%) experienced adverse reactions after the transfusion: restless leg syndrome associated with iron overload (75%), reduced daily living and functional capabilities (50%), emotional and mental health issues (anxiety, depression) 50%, fatigue (50%) pain (50%).
For all patients, the benefit of blood transfusion is not sustained over time
Participants scored their stress level regarding transfusion at 75%, with 100% being very stressful.
Participants scored the transfusion impact on QoL at 86%, with 100% having a significant impact
Participants scored the transfusion impact on their mental and emotional well-being at 89%, with 100% having a significant impact
Participants scored the transfusion impact on their social activities at 83%, with 100% having a significant impact

For participants, receiving frequent transfusions is associated with several challenges: mental Health (100%), family responsibilities (75%), work-life balance (75%), having a good QoL (75%), transportation (25%), housing responsibilities (25%), budget struggles (25%), work challenges (25%)

Some blood cancers are associated with extreme fatigue, linked to anemia Blood transfusion is a treatment offered, assuming that increasing hemoglobin (Hg) levels will improve fatigue and QoL. However, the analysis does not find a clear correlation between Hg levels and fatigue. Moreover, cancer patients experienced a decline in their functioning capability and QoL despite frequent transfusions, as observed in the survey
Recently, studies have demonstrated a correlation between some debilitating symptoms (fatigue, depression, pain) and inflammation markers called cytokines. In these cancers, the level of cytokines in the blood is abnormally high. These observations explain why patients are still experiencing fatigue despite frequent transfusions. Also, anemia is often the consequence of cancer progression, so a targeted treatment provided earlier in the disease course could significantly benefit patients' anemia and symptoms burden
Two products currently under revision by Health Canada illustrate this exciting novel approach well.
Ivosidenib (TIBSOVO) Momelotinib (Ojjaara)

