Blood Transfusion & Iron Chelation

A blood transfusion is the process of transferring blood or one of its components from one person to another. Whole blood is only rarely transfused nowadays. Individual components of blood that are typically transfused include

• Red blood cells, which carry oxygen from the lungs to all parts of the body
• Plasma, the fluid in blood that carries blood cells throughout the body
• Platelets, which control bleeding by forming blood clots

Blood transfusions are required for many conditions:

• Red blood cell disorders including hemolytic disease of the newborn, hemolytic anemia, thalassemia, sickle cell disease, Diamond-Blackfan anemia, hereditary spherocytosis and, rarely, severe iron deficiency anemia
• Certain cancers such as leukemia and digestive system cancers that cause internal bleeding
• Bone marrow failure
• Loss of blood from surgical procedures
• Treatments such as chemotherapy, radiation therapy and immunosuppressive therapy, which can destroy blood-making cells in the bone marrow
• Thrombocytopenia
• Severe heart or lung disease

Before a child receives a blood transfusion, the blood is carefully tested and cross-matched to ensure compatibility with the patient. The transfusion is given through a needle or catheter (a thin, flexible tube) inserted in a vein. The child’s temperature, blood pressure and heart rate are monitored throughout the transfusion, which generally takes a few hours to complete.

Some children, especially those with sickle cell disease, require an exchange transfusion in which the patient’s red blood cells are removed and replaced with red cells from a donor.

Children whose medical condition requires chronic transfusions can develop iron overload, which can damage internal organs such as the liver, pancreas, heart and endocrine glands. Dana-Farber/Boston Children's can treat children with iron load with the use of iron chelation drugs. Specialized MRI monitoring of body iron by Ferriscan® and T2* techniques for the liver and heart are available at our center.

Dana-Farber/Boston Children's experts tailor iron chelation strategies from the drugs currently available and approved, and we participate in research studies of novel chelation agents to bring better choices to our patients in the future.