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Overview
In people with myeloma, cancer cells can crowd the bone marrow, preventing the generation of new blood cells. Myeloma treatments including
chemotherapy and radiation therapy can also destroy bone marrow, making it impossible produce new blood cells. In either situation, levels of blood components such as red blood cells and platelets can become too low, leading to dangerous complications. Too few red blood cells (anemia) means the blood cannot carry enough oxygen to the body’s tissues. Symptoms of anemia include fatigue, weakness, dizziness, headache, leg cramps, fast heart rate, and pale skin. Platelets are cell fragments necessary for normal blood clotting. Low levels of platelets (thrombocytopenia) can cause abnormal bleeding such as nosebleeds, red spots on the skin, and skin that bruises easily.

Doctors differ widely in their views on blood transfusions for people with myeloma. Some doctors believe that transfusions are an effective treatment for low levels of blood components, while others feel the potential benefits of blood transfusions are not worth the risks. Some doctors prefer to treat anemia with Erythropoietin (EPO).

What does it involve?
Blood transfusions replace blood components in people who have dangerously low levels. Whole blood is rarely transfused in cases of myeloma. Generally, donated blood is filtered and separated into components. People with myeloma may receive red blood cells only, platelets only, or other components as needed.

Blood transfusions are administered in a medical setting. A nurse will place an intravenous line (IV) and attach a bag of blood components to slowly enter the bloodstream.

Intended outcomes
The goal of blood transfusion is to replace blood components destroyed by myeloma or myeloma treatments. Blood transfusions can treat complications such as anemia and abnormal bleeding.

Results
A study published in 2015 reviewed results from 236 blood transfusions administered to 49 people with multiple myeloma who had been treated with Darzalex (Daratumumab). During the period of observation, only one participant experienced a reaction related to the transfusion.

Constraints
Side effects of blood transfusions are not common. During or immediately after a blood transfusion, some people experience fever, chills, skin rash or an outbreak of hives, nausea, back pain, shortness of breath, or discomfort at the injection site.

Some potential side effects of blood transfusions do not occur immediately. Modern testing for HIV, hepatitis, and other infectious agents makes infection highly unlikely, but there is always a small risk of becoming infected with a viral or bacterial illness via blood transfusion. Some people who receive blood transfusions may develop an immune reaction to a subsequent blood transfusion. Rarely, white blood cells contained in the donated blood can attack the recipient’s immune system, causing graft-versus-host disease (GVHD). In some cases, GVHD can become life-threatening. The risk of GVHD is lowered by irradiating blood products or processing them to remove white blood cells before transfusion. People who receive multiple transfusions of red blood cells risk developing iron overload, which may lead to damage of the liver or heart unless it is treated.

Very rarely, blood transfusions can cause life-threatening side effects including kidney damage or a drop in blood pressure.

For more details about this treatment, visit:

Blood Transfusion – Leukemia & Lymphoma Society
https://www.lls.org/treatment/types-of-treatmen...

Blood transfusions – Macmillan Cancer Support
https://www.macmillan.org.uk/information-and-su...

Outcomes and Management of Red Blood Cell Transfusions in Multiple Myeloma Patients Treated with Daratumumab (PDF)
http://files.shareholder.com/downloads/AMDA-KPI...

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