The primary method to treat<unk>  is by transfusing packed red blood cells. Transfusion is also one of the treatment strategies for beta-thalassemia patients and patients with myelodysplastic syndrome (MDS). Although transfusion of red blood cells cannot correct the underlying problems, it can improve<unk>  conditions. Side effects of treatment There are considerable side effects associated with the transfusion of red blood cells. Side effects include iron overloading, allergic reactions that lead to skin rashes and infections transmitted through transfusion. The most common side effect is iron overloading, which the severity of overload depends on the frequency, volume, and the amount of blood transfused to the patient. Approximately, 200 to 250 mg of iron is transfused per unit of blood. Iron overloading is resulted because human body cannot excrete excess iron from frequent transfusions, leading to accumulation of iron in blood. Iron in blood causes damage to important organs, such as the heart, liver, bone tissue and endocrine glands. Damage to vital organs leads to morbidities, including cardiovascular diseases and heart failure. The liver is normally involved in iron metabolism and storage and excess iron causes liver diseases, fibrosis and cirrhosis. Complications associated with the endocrine hormones may also occur, including diabetes. The risk of developing transfusion<unk> y related morbidities increases with patients’ ages. Treatment to reduce iron overloading To reduce iron overloading in blood, iron chelation therapy is commonly used together with transfusion. Necessity to initiate iron chelation therapy is determined by blood test and transfusion volume. Generally, blood with serum ferritin level that exceed 1000 ug/L and a transfusion of 20 units of red blood cells will require iron chelation therapy along with transfusion. There are three common iron chelators, including deferoxamine, deferiprone and deferasirox. The 3D structure of deferoxamine Deferoxamine Deferoxamine is injected into the body through the veins and is the most traditional chelation therapy available. This therapy, although effective, especially for patients with heavy iron overload, is considered very inconvenient. The injection has to be performed for a long duration of 8 hours for 5-7 times every week. Therefore, low compliance of patients is one of the major concerns of this therapy. Side effects include abnormal growth of bones and kidney damages. Deferoxamine is seldom used alone nowadays, but rather in combination with oral deferiprone to increase the effectiveness in reducing iron overload. Deferiprone forms a complex with excess iron in blood in a binding ratio of 3 to 1 (3 deferiprone: 1 iron). Formation of this complex reduce iron overloading. Deferiprone Deferiprone is an oral drug that is ingested by patients three times a day. Although patients are still required to visit the clinic frequently for complete blood count, the administering process by simply oral intake regularly is still less tedious when compared to deferoxamine. It is also effective in reducing cardiac-related diseases due to iron overloading. Major side effects of this drug are to the gastrointestinal system. Defasirox Defasirox is also an oral drug to mitigate iron overloading taken one dose per day by patients. It shares similar benefits of convenience with deferiprone when compared to deferoxamine, but however is of the highest cost. Side effects to the gastrointestinal and urinary system are common. The use of iron chelation therapy is not without concern. It can also cause skeletal changes that leads to bone disorders such as osteoporosis. Therefore, minimizing the need of transfusion when possible is still the best way in reducing iron overload. Other than physical side effects brought by transfusion, transfusion also poses stress psychologically and financially. Inconvenience brought by frequent transfusion interferes with the normal social lives of patients. As a result, lack of social ties make patients more vulnerable to psychiatric illnesses like depression. The high cost for repeated transfusion can also cause financial burden on the patient and his/her family. Subjection to physical, psychological and financial stresses brought by frequent transfusions and its related morbidities worsen the quality of life of most patients as the disease progresses. Alternative treatments As there are a number of drawbacks brought by frequent transfusions, directly treating the cause of<unk>  (e.g. myelodysplastic syndrome), if available, remains the optimal choice of treatment. Hematopoietic stem cell transplantation is a treatment for thalassemia that minimizes the need of transfusion in long term. However, it is not suitable for patients with organs that have already experienced certain degree of iron overload, and it may only be applicable to strong and young patients. While for transufsion-dependent myelodysplastic syndrome patients, lenalidomide is approved for treating lower-risk patients and hypomethylating agents can be used to treat higher-risk patients.
Transfusion-dependent anemia
Post-transfusion purpura
Acute hemolytic transfusion reaction
Acquired hemolytic anemia
Delayed hemolytic transfusion reaction
Acute posthemorrhagic anemia
Mixed autoimmune hemolytic anemia
Mechanical hemolytic anemia