Anyone require blood transfusion during chemo treatment?

I just had that discussion with my oncologist's NP 2 days ago. Part of their protocol is to consider transfusion if hemoglobin drops below 8.0.

After 11 months on Gemcitabine + Abraxane + Cisplatin, my hemoglobin has steadily declined and has been under 9.0 for 2 months now (8.3 last week) so they're willing to consider transfusion.

I've been living on caffeine most of the year. Just got an Rx for Ritalin last month, which has help with some of the chemo brain fog, but not really done anything for physical endurance (like jogging where I need hemoglobin to help transport oxygen) or even generic shortness of breath.

Two oncologists have been pushing me to go on "maintenance" (lowering or eliminating some of my 3 chemo drugs), pointing out in part that the heavy chemo will just require another transfusion down the road.

I kind of look at it like I've earned a transfusion after a year of this! 😉 More seriously, if my heavy chemo regimen is keeping the cancer under control for now, I don't think a transfusion every 3 months or so is too much to ask.

Have you gotten any insights yet from your doc(s) about this?

I am also on Gemcitabine + Abraxane treatment. My hemoglobin dropped to 8.4 and my oncologist also indicated that dropping to 8 to be cause for transfusion. I am on treatment every two weeks. My dosage for Ab is 85mg and Gemzar 1000mg. I am wondering how my dosage compare to others. Thanks for your reply. Any one else experiencing the same as we do?

pre-meds:
dexAMETHasone injection 8 mg (DECADRON)
fosaprepitant in NaCl 0.9% IVPB 150 mg (EMEND)
palonosetron injection 0.25 mg (ALOXI)

chemo:
PROTEIN-BOUND PACLItaxel (ABRAXANE) IVPB 235 mg 47 mL
CISplatin 47 mg in NaCl 0.9% 595 mL IVPB (PLATINOL)
gemcitabine 1,800 mg in NaCl 0.9% 322.34 mL IVPB (GEMZAR)

misc:
magnesium sulfate in water IVPB 2 g
NaCl 0.9 % bolus 500 mL
sodium chloride 0.9 % injection 20 mL

If you got transfusion, please share your experience. I will do the same. With transfusion, pray that my energy will return. With hemoglobin at 8.4 and below now, I am tired all the time.

I went around and around today with a different nurse than the one I spoke with last week, so there was some rehash, but my understanding as of today is:

If you're having symptoms, they would do the lab work (typing & screening to identify the best blood match) right away, and if you qualify for the transfusion (generally hemoglobin < 8.0 but possibly some exceptions), they would have to do it within 72 hours.

Since I make this 5-hour round trip every two weeks for chemo, I told them I could hold off for another 10 days, but promised to exhibit more symptoms and lower hemoglobin when I get there. 😉

So, hopefully a transfusion in that time frame and a report within 2 weeks of its effect.

I had a blood transfusions after become Septic in the fall of 2021. It was my most difficult time of my 2 1/2 years of treatments. I’m not doing well. I’m glad to have that behind me.

@henfayp ,

I was able to get a transfusion 2 weeks ago, and have felt better ever since (apart from the usual 2-3 day post-chemo blahs). Significantly better.

It's impossible for me to separate all the other variables and credit the transfusion alone as accounting for my improvement, but I would definitely do it again. I was actually able to jog (slowly) a couple blocks during my nightly 2-mile power walk this week, both of which I haven't done in a while.

The official transfusion protocols are pretty hard to work around, and I feel lucky to have gotten what I did, but I would advocate for "the profession" to reconsider their protocols to be a little more flexible.

Various talking points have come up in my discussions with all the people involved. Among them, (quotes are paraphrased, not exact):

"Low hemoglobin affects different people differently. One person might feel worse at 9.0 than another person at 8.0"

"Maintaining a good performance status is one of the best indicators of longer-term survival." (In the context of reducing Abraxane to limit neuropathy and retain physical abilities/activities.)

"It doesn't make much sense to keep getting transfusions if the chemo keeps destroying your bone marrow."

"If you stop/reduce the chemo, hemoglobin should return to normal levels naturally in about 8 weeks."

"Studies have shown that exercise is better than any drug at combating chemo-induced and cancer-related fatigue."

"It's a blood product with all the associated risks, and is also in short supply."

My basic replies and rationale were:

I already have a (supposedly) terminal disease (Stage-IV pancreatic cancer). If there's a bad reaction to the blood transfusion, I can accept that, being no worse than the cancer itself.

If we're spending many, many thousands of dollars on chemo drugs, the cost to infuse a pint of blood is a miniscule add-on.

If I have to reduce or stop chemo in order to raise my hemoglobin to avoid fatigue, but let the cancer kill me, what have I gained? Do I have to choose between having energy and having my cancer under control?

If we're adding palliative care to my cancer care, and I've already tried exercise (couldn't tolerate), sleep adjustments, Ritalin, and reduced chemo, what's next to combat fatigue?

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It shouldn't be so hard. As I mentioned in an earlier post, I believe several months of chronically low hemoglobin is as bad as a temporary, acute low (< 8.0), especially in terms of remaining active and retaining a good performance status.

After caring for my dad in his battle with mesothelioma (and anemia that accompanied it), I can only imagine how much better he might have felt with something as simple as a transfusion. He "didn't meet the criteria" and 22 hours a day in bed did not help him at all.

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As a side note, we reduced my Abraxane by about 15% for the last two infusions, and my CA19-9 has gone up slightly each time. Too soon to call it significant, but not too soon to be suspicious of the correlation.

Thank you for the sharing. I was also transfused one unit when my hemoglobin dropped to 8.

@henfayp , How long ago was your transfusion, and how have you been feeling since then?

About two weeks ago. Feeling somewhat better.