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Information on Blood
Blood Tests
These are done to monitor your child’s blood disorder and the
effects of treatment.
Blood tests can usually be collected from a small fingerprick or
central venous line (if your child has one), but occasionally a
needle and syringe have to be used to take blood directly from a
vein.
Common blood tests performed are:
• Full blood count –to check the levels of red cells, platelets and
white cells in the blood.
• Electrolytes, Urea and Creatinine – to check for any chemical
disturbances and that the kidneys are functioning normally
• Liver function test –to check on parts of the blood that may affect
the function of the liver.
• Coagulation studies
• Iron Studies
• Group and Cross Match
• Inhibitor levels
• Immunoglobin
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Blood Cells
What is blood?
Blood is made up of many different types of cells floating in liquid
called plasma. It carries oxygen from the lungs to the tissues;
nutrients from the alimentary tract to the tissues, hormones to their
target organs and waste products to the kidneys and lungs. Each
of the cells has a specific role and can usually be found in certain
quantities.
Taken from Neuro- Oncology Parent Handbook – Royal Children’s Hospital
Blood cells are made in the bone marrow. (Some cells are made
in the liver and spleen early in life, but most cells come from the
marrow after birth). As the old cells wear out, new ones replace
them.
Red cells are the most common blood cell. They contain the
pigment haemoglobin, which carries oxygen around the body. The
average life span of a red blood cell is 90-120 days.
Lack of red cells and haemoglobin is called anaemia and your
child may appear pale, sleepier than usual, and may become
breathless after exercise or mild activity. Contact the hospital if
notice any of these signs. Anaemia can be easily corrected with a
blood transfusion. Red blood cells received from a transfusion
have a shorter life span of about 30 days. For further information
about transfusions see the ‘Transfusion section’ of the folder.
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Platelets are involved in blood clotting. When the platelet count is
very low (called thrombocytopenia), the child may bruise easily
and some times can have nosebleeds. They may also develop
petechiae, which are small red spots under the skin. If any of
these occur contact the hospital. Low platelet counts can be
corrected with a platelet transfusion (see transfusion section).
White cells are part of the body’s defence system against
infection. There are 2 important types of white cell:
•
Neutrophils – important in fighting bacterial infections.
When the neutrophil count is less than 1.0, the child is said to be
neutropenic and is at risk of serious bacterial infections, often with
bacteria from within their own body. The lower the white cell count
falls, the greater the risk of infection.
•
Lymphocytes – important in fighting viral infections and in
producing special proteins called antibodies, which help destroy
viruses and bacteria.
Plasma
Plasma contains water, proteins, mineral salts, nutrient material,
waste products, hormones, enzymes, antibodies and gases. These
substances are vital for the body to function normally.
The mineral salts include sodium, potassium, chloride, calcium and
magnesium and referred to as electrolytes. Electrolytes carry
electrical charges that enable your heart, nerves, and muscles to
work properly. The kidneys help to regulate the balance of
electrolytes by selectively keeping or getting rid of each salt.
The plasma also contains proteins such as albumin and globulin,
and they control the flow of fluid from the blood system to the cells.
The organic waste products of metabolism are urea, uric acid and
creatinine and indicate how well the kidneys are working.
Your doctor will discuss blood results with you and how they relate
to your child’s treatment.
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Anaemia
Anaemia is a low red blood cell count. The symptoms of anaemia
are:
•
Sleepiness
•
Breathless or a rapid heartbeat
•
Dizziness or light headedness, inability to concentrate or
headache
•
Signs of bleeding
•
Pale skin
Contact the hospital if you notice any of the above symptoms.
The following could help you manage the symptoms until the
anaemia resolves or you have a blood transfusion:
•
Arrange child’s activities to have time to rest
• Eat a well balanced diet and drink lots of fluids. (Refer to the
nutrition section for advice)
•
Rise slowly after sitting or lying to prevent dizziness.
To correct anaemia a blood transfusion is given as a drip over a
few hours and can usually be done on an outpatient basis. White
blood cells are removed by filtering, and all blood products are now
irradiated before use to help reduce the risk of reaction. Despite
these precautions there is a very small risk of reactions or
infections from blood.
Transfusions
During your child’s treatment specific blood products may be
needed to top up your child’s own blood supply. They may require
a red blood cell transfusion (if your child has anaemia, a low red
cell count) or a platelet transfusion (if your child has a very low
platelet count or is bleeding).
Are transfusions safe?
Blood donations are carefully checked for viruses (such as HIV
and hepatitis) and bacterial infections that might be transmitted by
the transfusion. This means that the risk of viral /bacterial infection
from blood components is extremely low.
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Doctors only order transfusions when they are really needed.
All blood products given to your child will be:
• screened for CMV (cytomeglovirus) – this can cause problems in
patients with low white blood cell counts
•
irradiated - to reduce the risk of reactions
•
white cell filtered - to further reduce the risk of reaction.
Can a family member or I donate blood to be given to my
child?
This practice is not recommended as studies have shown that this
type of donation is no safer than blood donated through the Red
Cross.
It is unlikely that a single donor will be able to meet all the
requirements that a child receiving treatment may need.
If you/ or family members still wish to donate although it will not be
used for your child you may donate to you local Australian Red
Cross Blood Service.
Please discuss this further with your doctor if you have any
questions.
What tests are required prior to a transfusion?
A blood count will show the levels of red cells and platelets. If the
red cells are low enough for your child to need a red cell
transfusion then a blood sample will be taken to match the donated
blood with your child’s blood. This is called a cross match. It is
done to check that the donated blood and your child’s blood are
compatible to reduce the risk of reactions. A cross match blood
sample is needed for each red blood cell transfusion. It can take
up to several hours to prepare the correct blood to give to your
child, plan that you may need to be at the hospital for the whole
day.
Platelets need to be from a compatible blood group. It can take
several hours to obtain the best platelets, as they may need to
come from Red Cross or even another hospital.
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Treatment for Anaemia
Red Cell Transfusion (Blood transfusion)
Your child may be given red blood cells if the red cell count is low
or they have lost blood from an injury or during surgery. This can
be done if your child is a patient in a ward or as an outpatient in
McGuiness & McDermott Foundation Children’s Clinic.
The amount of blood given will depend on the size of your child
and how low the red cells count is.
A blood transfusion is given intravenously either by an IV line or
through your child’s central line or port.
The whole transfusion usually takes 4 to 6 hours to infuse but can
sometimes be longer if the red blood count is very low.
During the transfusion your child will be observed for any sign of a
reaction such as:
•
Temperature / rigor (uncontrolled shivering)
•
Rash
•
Finding it hard to breath
The most common reactions can be controlled with medications,
but children sometimes need to stay in hospital overnight for
observation after a reaction.
Bleeding
Platelet numbers may fall low enough to cause minor and major
bleeding problems. This is called thrombocytopenia. If the platelet
count falls to a very low level a platelet transfusion will be given to
prevent possible bleeding. The ability of platelets to help blood clot
is severely affected by even small doses of aspirin. This drug is
not recommended if your child has a blood disorder. Paracetamol
is a safe and equally effective substitute. There is a list included in
the home care section showing the medications that contain
aspirin. The following steps will help minimise the chance of
bleeding:
• Use a soft toothbrush – unless bleeding or sore mouth in which
case use as mouthwash – discuss this with your Doctor.
•
Use a lip balm to keep lips moist and prevent cracking
•
Blow nose gently
•
Caution with physical activity when platelets are low.
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If your child has bleeding from the nose, gums and /or mouth or
unexplained bruising please contact the hospital. Bleeding can
also occur in the bowel, which would show as red streaks in a
bowel action or black bowel actions. If urine is pink or vomit is red
or a coffee colour then this may be a sign of bleeding and you will
need to contact the hospital.
Platelet Transfusion
Platelets stop your child bleeding by sticking together to form a
plug. When platelets are low your child may bruise easily or they
may bleed from the nose, gum or other part of the body.
A platelet transfusion can be given if your child is a patient in a
ward or as an outpatient in McGuiness & McDermott Foundation
Children’s Clinic or after hours in the Emergency Department.
The size of the platelet transfusion will depend on the size of your
child.
Platelets can be given intravenously either through an IV line or
through your child’s central line or port and it will take about half an
hour.
During the transfusion your child will be observed for any sign of a
reaction such as:
•
Temperature / rigors (uncontrolled shivering)
•
Rash
•
Finding it hard to breath/ wheeze
•
Vomiting
If your child has a reaction it can be controlled with medications. If
a reaction occurs then for all other platelet infusion your child will
receive a pre-medication to help prevent reactions.
Should I keep track of my child’s results?
It is important that you keep track of your child’s blood results.
Your doctor will discuss all the results with you and either give a
copy of the results or write them down for you to keep.
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Normal Blood Count Values
Haemoglobin
<2
years
2 – 12
years
12 years adult
10 -13
11 -14
13.0 –18
Male
g/L
11.5 –
16.5
Female
White Cell
Count
6 -11
5 -11
4 –11
1-5
1.5 - 7
2 – 7.5
2 - 10
2-7
1.5 - 4
X 10∧9/L
Neutrophils
X 10∧9/L
Lymphocytes
X 10∧9/L
Platelets
150 -450
150 -450
150 -450
X 10∧9/L
Where can I find further information?
•
Ask your doctor/nurse
• ‘Blood Components – A Guide for Patients’. Feb 2002 from
www.nhrmc.gov.au
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