Blood Cell Levels and Transfusions

The three main types of blood cells are red blood cells, white blood cells and platelets. Each has a specific job to do, and the level of each type may be affected by the chemotherapy and/or radiation you receive before your BMT. To ensure adequate levels of each type, your blood will be monitored regularly, and transfusions will be given as necessary.

Red Blood Cells (Erythrocytes or RBCs)

RBCs, which give blood its red color, carry an iron-rich protein known as hemoglobin, which picks up oxygen from your lungs and carries it to all the cells in your body. When your hemoglobin level is low (anemia), you may feel weak or dizzy, lack energy, be short of breath, have headaches and/or become irritable. If you become anemic, your doctor will order a red blood cell transfusion; you will receive one or more bags of packed red blood cells as needed to keep your hemoglobin level above eight.  Each bag will be transfused over two to three hours. This blood will have been typed and cross-matched with your blood to confirm that you and the donor have the same blood type, thus minimizing the chance of a reaction. However, if you do have a transfusion reaction, the symptoms might include chills, hives, itching and/or breathing problems. If you have any of these symptoms, please notify your nurse immediately. Because RBCs have a longer lifespan than platelets, you usually will not need RBC transfusions as often as platelet transfusions.

Platelets (Thrombocytes)

Platelets are the smallest components in blood; they play a crucial role in causing blood to clot and preventing excessive bleeding.  Without enough platelets (a condition called thrombocytopenia), spontaneous bleeding and unexplained or excessive bruising may occur.  Normal platelet values are between 150,000 and 300,000 per microliter of blood. To help prevent bleeding, you may be given transfusions of platelets, generally if your count is less than 10,000 to 20,000. Platelets may be transfused more frequently if there is active bleeding or before any invasive procedures.  Transfusions may be given as often as once every 12 hours or as infrequently as every three to four days until your bone marrow begins to produce its own.

White Blood Cells (Leukocytes, WBCs)

WBCs defend your body against disease-producing bacteria, viruses, parasites, fungi, foreign substances and tumor cells. There are three main types:

  • Monocytes defend the body against bacterial and fungal infections.
  • Neutrophils (granulocytes) are the body’s first line of defense against infection.  The bone marrow can quickly speed up production of these cells whenever they are needed.  They combat infection by rapidly mobilizing into the bloodstream where they respond to the presence of bacteria or foreign substances. When the infection is controlled, their production returns to normal.
  • Lymphocytes patrol the bloodstream, the lymphatic system and the lymphoid organs (spleen, thymus, thyroid, lymph glands) looking for disease-producing foreign substances and tumor cells. There are two main types: B cells and T cells. These cells are involved in defense against bacterial, fungal and viral infections.

A normal total WBC count ranges between 5,000 and 10,000 cells per microliter of blood. Another numerical term you may hear is 5 to 10, which is an abbreviated way of saying 5,000 to 10,000. Neutrophils account for approximately 50 percent to 80 percent of the total number of WBCs. You have neutropenia when your neutrophil count is low. Your risk of infection increases if your count is 1,000; the risk increases dramatically if your count is below 500. Your WBC and absolute neutrophil count (ANC) will be monitored daily. Generally, as the overall number of WBCs increases, so too does the number of circulating neutrophils.

Safety of Transfusions

All blood products are carefully tested for all types of hepatitis, HIV and syphilis, according to federal requirements. Cytomegalovirus testing will be done if your doctor decides it is needed. All blood products are irradiated and filtered to help eliminate the chance of reactions from white blood cells.