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
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)
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.
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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.
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.
Generally, Anemias can be a disease, but much more often they are a symptom of an underlying disease.
Iron deficiency anemias are commonly due to an unknown bleeding. So replacing lost blood doesn’t fix the underlying problem.
You can’t fix a boat taking in water by scooping out the water. But you can get enough time to fix the boat if you scoop out the water first.
My sister has iron infusions every now and then. No need for blood transfusion, just iron via IV.
I worked in a clinic that did phlebotomies for people with hemochromatosis. We looked in to this. The ferritin is a protein and in the massive quantities that our patients had, the blood would likely cause a reaction, possibly like anaphylaxis, in the recipient. Once someone was within range, they could donate blood again, if they only needed it every 56 days. More often and we had to do it.
Anemia actually isn’t just low iron, there is IDA (iron deficiency anemia) but there is also a whole host of other types like aplastic anemia, sickle cell anemia, anemias that are vitamin dependent, and so much more!
In an emergency, they could (assuming the blood bank accepts donors with hemochromatosis – the American Red Cross does not).
But the bigger reason not to do this is that there are significantly easier and less invasive ways of treating most forms of anemia. Blood is a scarce resource, and blood transfusions are not a risk-free procedure. Every unnecessary blood transfusion risks generating immunity against the hundreds of blood group antigens that are not a match between the donor and recipient.
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