why can’t people with anemia (not enough iron in blood) get blood transfers from donors who have hemochromatosis (too much iron in blood)?
In: Biology
Two points to make about your question:
1. Anemia may be due to low iron, which causes ineffective red blood cell production in your bone marrow, but more broadly anemia just means you have a low number of red blood cells around (which we characterize by measuring the hemoglobin or hematocrit on a routine lab test called a CBC). If the anemia is severe, you may require a blood transfusion but otherwise we try to treat the underlying cause of the anemia. If it’s due to low iron we can give iron supplements (either orally or through an IV). Or if it’s another cause (like bleeding) we try to address that problem.
2. Practically speaking hospitals use what’s called packed red blood cells (PRBCs) from a blood bank (most hospitals have their own) for transfusions. These have been processed, tested, and have preservatives added. So while we theoretically could take blood directly from someone and give it to someone else (assuming the blood types are compatible) it’s not a very scalable process.
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My wife has to get iron infusions every so often as an autoimmune disease has left her with the same side effects as leukemia.
It isn’t a blood infusion, but rather more like an IV that boosts the iron in her system.
It’s actually pretty uncomfortable as it creates the sensation of burning in the arm and across the body and can get pretty painful. It also takes around 6-8 hours depending. The more painful it gets the slower they cut down the drip which also extends the time the infusion takes.
Not seeing the correct answer to your specific question, so I’ll jump in.
To start, we need iron to make healthy red blood cells.
Anemia isn’t a lack of iron, it’s a lack of red blood cells. Low iron is one common cause, but most of the time this anemia isn’t severe enough on its own to need a transusion. Most of the time, just giving more iron is easier and safer, and our body can do the rest. Importantly, there are other conditions that cause anemia that DO require transfusions more often, like cancer and sickle cell disease. In these patients, there is no lack of iron to start with, they just can’t use it effectively.
In hemochromatosis, patients gradually get too much iron in their bodies. This can damage different organs, especially the liver. Drawing off blood forces their bodies to make red blood cells faster than usual, and use up the iron.
If someone gets a lot of transfusions, they can actually end up with too much iron in their bodies. This happens because some of the transfused cells break down quickly and release their iron too fast, and because your storage still isn’t being used up. If they get blood from people with hemochromatosis, that injury could happen more quickly, because those donors often have more iron to start with.
That’s the theory underlying the rule in the US at least. I’m not sure how big a difference there is on a practical level, and I’m not sure what rules are in other countries.
They can, but indirectly.
You may have heard of ABO blood group. That’s just one (and the most significant) of the antigens possible. There are over 700. Every time someone gets a transfusion in a non-emergent setting, the recipient blood is checked against the donor blood.
Anemia isn’t just a lack of iron in the blood – iron-deficiency anemia is just one of many causes. Transfusion of blood to someone with anemia NOT due to iron deficiency can actually lead to iatrogenic (i.e. caused by the healthcare system) iron overload. This is commonly seen in patients with anemia due to thalessemia. In addition, as others have said, even if the recipient is anemic due to iron deficiency, the underlying cause should be treated or else it is a futile exercise.
Every blood transfusion is also associated with significant risk. See [pages 42-44 of this guide.](http://policyandorders.cw.bc.ca/resource-gallery/Documents/Transfusion%20Medicine/Bloody%20Easy%204.pdf)
Anemia is not necessarily “not enough iron in the blood.” That can cause anemia, but a better definition would be any condition that causes your blood to not be able to carry oxygen as efficiently. This could be due to not enough iron (as iron is an essential part of hemoglobin, the protein in red blood cells that carries oxygen), but it could also be due to not enough vitamin B12 or folate (which your body uses to help make blood cells), or the red blood cells being the wrong shape (as in sickle-cell disease), or not enough RBCs being produced, or from RBCs being broken down too quickly… basically there are a number of things that can cause anemia, but infusing blood with more iron than normal isn’t going to fix all of them, and in any case the effect would be temporary.
Two issues with hemochromatosis:
-Theoretical risk for iron overload in the recipient, especially in those with childhood anemias (ex: sickle cell, PKD, etc).
-Theoretical risk for anaphylaxis.
Both risks are minuscule and you’d be hard pressed to find a hematologist who agrees with this logic, but the counterargument is “why bother risking it unless there’s a major shortage” so that’s where it stands in the US.
Another thing to understand from the iron-deficient patient side is that we avoid giving blood products to these patients because their body will eventually develop antibodies to the donor blood (alloantibodies), making it so they “reject it” with time. So say later on they get in a car accident and need blood more urgently, they now have to wait ~24 hours to find a suitable donor since they have alloantibodies to the majority of donor blood (ex: anti-Duffy). Just a rough example.
People who need a transfusion can get red blood cells from ordinary donors; it is easier to find and doesn’t require match ups. People with an excess do sometimes have supervised blood lettings that may involve donation if they don’t have other problems.
I know my red blood cell count went down very low during chemo, and I wasn’t given a transfusion. Blood transfusions have risks. Before they tested for HIV, hemophiliacs who receive concentrated blood products died in great numbers.
Because the Red Cross doens’t accept blood from people with hemochromatosis, even though it’s mutually beneficial for both the hemochromatic patient (because they need to lose blood) and for the average blood loss patient (because iron rich blood is better for blood loss), because the Red Cross considers certain people icky and having tainted blood, like gay people and convicts, and of course people with hemochromatosis.
I have hemochromatosis, and am type O-. I have no other diseases and am in good health. I am a dream donor. The Red Cross is obsessed with blood purity to a fault and will not allow me to give blood.
Important thing others have left out – anemia isn’t only caused by low iron. Sometimes, a B12 deficiency causes low iron absorption (called pernicious anemia) and in that case adding iron will not help. In other cases, it is caused by your body not producing enough red blood cells to carry the iron, which is sickle cell anemia and also cannot be fixed by adding iron. Hemolytic anemia is also an issue with red blood cells, where they are deformed and die quickly. This solution will not help those people
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