HOW MANY OF U R USING DESFERAL WHILE TRANSFUSION IS GOING ON - Thalforum

mohak_arora · February 6th, 2005, 04:01 PM

HOW MANY OF U R USING DESFERAL WHILE TRANSFUSION IS GOING ON I MEAN, DESFERAL BY INTRAVINUS WITH THE BLOOD TRANSFUSION.
MOHAK

vamanjani · February 6th, 2005, 08:48 PM

Hi everyone,
ATsome medical centres, DFO is introduced into the vein at the same time as the patient receives his/her blood transfusion. However, DFO must never be addeded directly to the blood being transfused to the patient as it may contaminate the blood or cause reaction. In general, no substance should be addeded to a patient's blood transfusion, unless it is scientifically proven that it cannot cause any harm.
In order to deliver DFO intravenously during the blood transfusion, the required amount of DFO is dissolved in a solution called normal saline. A needle from the bag containing the DFO solution is then inserted into y-connector with the blood bag attached to be administered to the patient over a period of about 4 hours. If preferred, a pump may be used during the infusion. Often the time needed to effectively infuse a dose of DFO is longer that that reuired for a blood transfusion.
It is important to note that DFO administered only during blood transfusions i.e. once every two/four weeks - has extremely limited effect. However, this may be the only option where DFO is in short supply. On the other hand, some centres administer DFO intravenously during patients blood transfusion therapy in addition to their regular daily treatment., in an effort to improve overall effectiveness of iron chelation treatment.
It is important to note that the intravenous use of DFO should be introduced with caution and only where necessary; over the longer term, the method may damage veins that are essential for blood transfusion therapy, and it carries a higher risk of infection.
It will be interesting to know that when DFO was first intorduced for the treatment of thalassaemia, it was administered by intramuscular injection. However, it has since been found that the method is not as effective as subcutaneous or intravenous infusions.
Intramuscular injections are still used in some cases - for example, in countries where DFO is proibitively expensive and therefore only available in very small quantities, or where infusion pumps are not available. There is considerable evidence that patients are better off receiving atleast some DFO, in whatever way, rather than none at all. Therefore, if there is no alternative, DFO can be administered by intramuscular injection.
Another technique is to dissolve 500 mg in 5ml of distilled water, and to inject it into a muscle of the arm or leg. The dose is divided into two and administerd twice each day - a technique recently shown by some investigators to be quite effective.
Hope, this will enlighten our members and viewers. Thanks
Vaman Jani

Vik · February 6th, 2005, 09:18 PM

Quote:

Originally Posted by mohak_arora

HOW MANY OF U R USING DESFERAL WHILE TRANSFUSION IS GOING ON I MEAN, DESFERAL BY INTRAVINUS WITH THE BLOOD TRANSFUSION.
MOHAK

Mohak,
IMO, I do not see any harm of taking desferal during, after or before bld. transf. (BT). {not putting in the blood bag....nope}

Desferal does not react with blood in any way...as long as the rate of infusion is set properly taking desferal is certianly not bad.
(pls consult a dr. for an opinion)

*****The only thing that is known to react with deferal is heparin. It is recommended to flush the tubing properly (to remove heparin if the tubing contains it) BEFORE starting desferal on the same tube.

Vik

vamanjani · February 7th, 2005, 12:14 AM

Dear Vik,
Further to my mail to you, I would rather suggest that all members go thru the thread iron overload and iron chelation and to know properly the right and safe method of chelating iron from the blood.
Dr Piga, during the international conference on thalassaemia in New Delhi held from 5th to 7th November, 2004 has also suggested that desferal should be taken subcutaneously and very slow; say within 8 to 12 hours by a portable pump and good quality needle to be used. Safe tissue iron level should be maintained at 1000g/l. Iron concentration in lever 3.5mg/d.w.
Hope, this clarifies you further.
Vaman Jani

Vik · February 7th, 2005, 09:38 AM

Hi Vaman, I agree.
During bld.transf. - the IV desferal should be taken just at the same speed as subQ (8-12 hrs) & not any faster.

***Nothing should be mixed in the bld bag.

mohak_arora · February 7th, 2005, 02:17 PM

Quote:

Originally Posted by Vik

Mohak,
IMO, I do not see any harm of taking desferal during, after or before bld. transf. (BT). {not putting in the blood bag....nope}

Desferal does not react with blood in any way...as long as the rate of infusion is set properly taking desferal is certianly not bad.
(pls consult a dr. for an opinion)

*****The only thing that is known to react with deferal is heparin. It is recommended to flush the tubing properly (to remove heparin if the tubing contains it) BEFORE starting desferal on the same tube.

Vik

hi vik,
ya we do not put in our blood bags .
but we put in the same tube with a help of a three way.
ya i truly agree with u but some children r using it like this way.
i also tried it .
thanks
mohak

hamid · February 14th, 2005, 07:03 AM

Hi friends:
desferal infusion during blt has limited effect in removing iron stores.If you adhere to your pumps six night per week it is unnecessary.But for pts who are poor compliance with sc desferal it can infuse max.2 gr without additional needle.But remember that is not enough for lowering ferritin.
thanx
hamid

MELIS · February 27th, 2005, 07:32 AM

In the Nederlands I have never had Desferal while a get a bloodtransfusion.. only each night so after the transfusion.. But in Turkey I got 1 time desferal during bloodtransfusion..

mohak_arora · March 5th, 2005, 10:37 PM

Quote:

Originally Posted by MELIS

In the Nederlands I have never had Desferal while a get a bloodtransfusion.. only each night so after the transfusion.. But in Turkey I got 1 time desferal during bloodtransfusion..

hi every1,
thanks for posting u r thoughts and experience in this thread.
mohak

Danielle · July 25th, 2005, 10:19 AM

I have never heard of Desferal being piggybacked into the same tubing as blood, at the same time. In fact, I think that's highly dangerous. In New York, we infuse Desferal separately, either before the blood, or after the blood, but never at the same time. If a reaction were to take place, there would be no way to decipher whether it was the blood or Desferal this way, and that is very dangerous.

I'm only saying this because I am very cautious when it comes to transfusion (or any) reactions. I had a severe transfusion reaction in March 2000 that left me on life-support, and it's a miracle I even lived through it. I had a Transfusion Related Acute Lung Injury (TRALI), which is very deadly. Blood transfusions are not something to take lightly, and they should only be given by themselves. If Desferal is to be given into the same vein as blood, then the blood should be finished, the line should be flushed, and then the Desferal should be given afterward.

This advice is given as a patient with Cooley's Anemia, and my training as an RN. Please be very careful using both at the same time, and watch for reactions either way.

Vik · July 29th, 2005, 04:04 PM

Hi Danielle,

Ya, in India, lot of patients used to do this.. put desferal (mixed with saline/water) directly in the blood bag. I myself have used desferal like this for years. Infact, they also did this in Montreal Thalassemia Clinic for many years.

Some people believe (includ. myself) that desferal is VERY effective this way.

In Montreal however, they have now stopped this practice, NOW they use a seperate bag that has desferal mixed with saline that us infused in the same tube as the one with the blood.

The reason for giving desferal this way was mainly because
1. many people could not afford expensive disposable that are required to give Desferal subQ.
2. While others can only give desferal once at the time of blood transfusion becuase it is VERY expensive in countries where it is not covered under healthcare or insurance.

but you are absolutely right!!

Quote:

Originally Posted by Danielle

I'm only saying this because I am very cautious when it comes to transfusion (or any) reactions.

Vik

vikaskapoor · July 29th, 2005, 04:22 PM

dear vik,
i think you are living in ice age mann , it was loon long time back when doctors recomend that , but now a days we take desferal during desferal with two way attached in our veinflow.in india nobody takes desferal with salin. and mixing desferal in blood bag ...paaji what happened to you few days earlier i was talking to my doctor about this and he scolded me just by hearing this.he said most of the time you will get reactions taking desferalthat way . now you see how .. in india which thal center do you go vik ...just for info..

regards
vikas

regards
vikas kapoor

Neel_R · August 25th, 2005, 10:34 AM

I've been getting desferal with my blood (same tubing;different bag) since I was 3. And that was over 21 years ago now. It works great, and have only had several reactions, 95% of them being before the blood was filtered proplery...so many years ago.
I dont believe you can get a reaction due to desferal. BUT DONT QUOTE ME. All my reactions have been from the blood.

Also it is mixed with saline when they give it. I get it over about 6 hours with 3 units (sometimes 2) every 2 weeks.

I also had a PIC line which was VERY effective, my iron level dropped to those with no health problems, a little to low for Thala's.

Pranav · August 26th, 2005, 03:46 PM

hi
i used to take desferal with blood,but i started having reactions,such as iching & redness on my arms.This did not happen once or twice but every time so i stopped taking desferal with blood.
As vikas has mentioned now nobady here take desferal with salin or mixing itl in a blood bag.

Pranav

Danielle · August 30th, 2005, 05:19 AM

Quote:

Originally Posted by Neel_R

I dont believe you can get a reaction due to desferal. BUT DONT QUOTE ME. All my reactions have been from the blood.

It is very possible to get reactions from Desferal. I have had them myself. I was actually admitted into the ICU because of serious reactions I used to get from it. They had to *desensitize* me, which is a process of feeding little amounts of Desferal into a patient intravenously (or subQ), to get the body used to it again. I was breaking out in hives all over my body, and also had breathing problems when I would start my pump. So, any kind of medication, no matter what it is, can cause severe reactions. I didn't start getting reactions to Desferal until I was already using it for 16 years. Ever since I was desensitized, I haven't had any problems with it, and it's been 9 years now.

So please, never underestimate the power of medicine! It can be a wonderful thing, and an awful thing. And please don't think that if you've been using it for years and nothing has happened that nothing will EVER happen, because that is not how the body works. The body can become allergic to anything, at any time, even if you have been using a particular medicine for years.

This is why I am not in favor of ANYTHING being infused with something else ... especially blood and Desferal. I completely understand that there are people who need Desferal and cannot afford to get it any other way, and in that case, an exception must be made, because they need to get the Desferal somehow. But, if this can be avoided, then I do not recommend mixing two different types of treatment together.