Supportive care and transfusions
Leukemia treatment is not only about medicines that destroy leukemia cells. For treatment to succeed, protecting and supporting the body along the way is just as important: blood transfusions, infection prevention, anti-sickness medicines, kidney protection and emotional support. This topic explains in plain language the main parts of supportive care, especially blood transfusions.
01Short answer
02Simple explanation
Leukemia and its treatment stop the bone marrow from making healthy blood cells. This leads to three problems: anemia (tiredness, breathlessness), thrombocytopenia (bleeding, bruising) and neutropenia (infections).
To fill this gap for a while, blood components from donors are transfused: red blood cells for tiredness and breathlessness, and platelets to prevent bleeding.
Neutrophils are not usually transfused. Instead, hygiene rules, preventive medicines and sometimes growth factor injections that speed up neutrophil recovery are used to prevent infection.
When large numbers of leukemia cells die at once, their contents pour into the blood and can damage the kidneys. This is called tumor lysis syndrome. At the start of treatment, plenty of fluids and special medicines prevent it.
Supportive care also means feeling better: controlling nausea, pain and mouth sores, advice on nutrition, and psychological support. These are not an “extra” to treatment but an important part of it.
03Scientific explanation
Red cell transfusions: the 2023 AABB international guidelines recommend a restrictive approach for most stable adults in hospital, considering transfusion when hemoglobin falls below about 7 g/dL (70 g/L); for some people with heart disease the threshold may be higher. The decision is based not only on the number but also on symptoms and overall condition.
Platelet transfusions: according to the 2015 AABB and 2018 ASCO guidelines, in adults whose platelets are low because of treatment, preventive transfusion is usually given when platelets fall below 10×10⁹/L. A higher threshold may be used with bleeding, high fever or invasive procedures (such as placing a catheter).
Specially prepared blood: according to the 2020 BSH guidelines, irradiated blood components are used in certain groups, such as people having a stem cell transplant and those treated with purine analogues like fludarabine, to prevent transfusion-associated graft-versus-host disease. According to WHO, safe blood should come from voluntary donors and be screened for HIV, hepatitis B, hepatitis C and syphilis.
Infection, nausea and tumor lysis: the 2018 ASCO and IDSA guidelines describe urgent assessment of fever during neutropenia and treatment according to risk level. The 2020 ASCO guidelines set out medicine combinations to prevent nausea (for example 5-HT3 blockers such as ondansetron, NK1 blockers, dexamethasone and olanzapine). According to a 2011 review, prevention of tumor lysis syndrome consists of intravenous fluids, medicines that lower uric acid (allopurinol, rasburicase) and regular blood tests.
04What happens in the body?
What happens during a transfusion?
First your blood group is determined and compatibility with the donor blood is checked. Before the transfusion, the nurse carefully matches your name and details against the blood bag. One unit of red cells usually takes a few hours to transfuse, and platelets take less time. Pulse, blood pressure and temperature are monitored throughout.
Transfusion reactions
According to the American Cancer Society, reactions are usually mild: fever, chills, itching or a rash. Rarely, serious reactions occur, such as shortness of breath, back or chest pain, or a drop in blood pressure. If you feel unwell during or after a transfusion, tell the nurse straight away; the transfusion will be stopped and checked.
Preventing infection
When neutrophils are very low, even ordinary germs can cause a serious infection. That is why hand hygiene, food safety and, in some cases, preventive antibiotic, antifungal and antiviral medicines are used. A fever during neutropenia is an emergency: call straight away at the temperature your team has given you, and do not take a fever medicine and wait.
Nausea, mouth care and nutrition
Anti-sickness medicines are usually given before chemotherapy and may be continued at home; take them as prescribed, without waiting for nausea to start. A soft toothbrush, alcohol-free mouthwashes and regular mouth care help prevent mouth sores. A dietitian can help when appetite is poor.
Emotional and practical support
A leukemia diagnosis and long treatment are a heavy burden for both the patient and the family. A psychologist, social worker, support groups and the palliative care team can ease this burden. Palliative care does not only mean the end of life; it is there at any stage to reduce symptoms and improve quality of life.
05What does supportive care protect?
Four areas of support for the body throughout treatment.
06Blood components and what they are for (simplified)
| Component | Why it is given | Note |
|---|---|---|
| Red blood cells | Anemia: tiredness, breathlessness, a racing heart | Threshold and symptoms are assessed together |
| Platelets | To prevent or stop bleeding | The threshold may be higher before procedures |
| Plasma | A shortage of clotting factors | For example in some bleeding disorders |
| Cryoprecipitate | Low fibrinogen | May be used in clotting disorders such as those seen in APL |
| Irradiated components | To prevent transfusion-associated GVHD | After a transplant and certain medicines |
| Immunoglobulin | Very low antibodies and repeated infections | For example in some cases of CLL or after CAR-T |
* When a transfusion is given, and which component, is decided only by your hematology team. The numbers are a general guide only.
07Key terms
- Supportive care
- Help that prevents and eases problems caused by leukemia and its treatment.
- Transfusion
- Giving donor blood or one of its components.
- Anemia
- Low red cells and hemoglobin.
- Thrombocytopenia
- Low platelets, which raises the risk of bleeding.
- Neutropenia
- Low neutrophils, which raises the risk of infection.
- Growth factor
- A medicine that speeds up neutrophil production.
- Irradiated blood
- A component treated with radiation to inactivate donor lymphocytes.
- Tumor lysis syndrome
- A dangerous change in blood chemistry when many leukemia cells die.
- Antiemetic
- A medicine against nausea and vomiting.
- Palliative care
- Care that reduces symptoms and improves quality of life.
08Key points
- Supportive care is an important part of treatment.
- Red cell transfusions relieve anemia.
- Platelet transfusions prevent bleeding.
- If you feel unwell during a transfusion, say so straight away.
- A fever during neutropenia is an emergency.
- Take anti-sickness medicines as prescribed.
- Tumor lysis is prevented with fluids and medicines.
- Emotional support and palliative care are available at any stage.
09Frequently asked questions
Is a blood transfusion safe?
Donor blood is carefully screened and compatibility tests are done, so serious reactions are rare. Any feeling of being unwell should be reported straight away. Ask your team any questions about the benefits and risks.
Why do platelets sometimes fall quickly?
Platelets live in the body for only a few days, and they are used up faster during fever and infection. That is why frequent platelet transfusions may be needed during leukemia treatment.
Can my relatives give blood for me?
It depends on the country and the centre. In some cases relatives are not advised as donors, especially if a transplant is planned. Voluntary blood donation, however, helps all patients; ask your centre about it.
When are growth factor injections given?
They are used in some treatment schedules to speed up neutrophil recovery. They are not needed in every leukemia or at every stage. Your hematologist decides.
What are the signs of tumor lysis syndrome?
There may be less urine, nausea, muscle cramps, an irregular heartbeat or weakness. Changes in blood tests often appear before symptoms, which is why blood tests are taken frequently at the start of treatment.
Does palliative care mean giving up on treatment?
No. Palliative care can be given alongside the main treatment. Its aim is to reduce symptoms such as pain, nausea, tiredness and anxiety, and to improve quality of life.
10Questions for your doctor
Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.
Why are my platelets low?
When is a platelet transfusion needed?
What are the risks of a blood transfusion?
Which reactions after a transfusion should I report?
12Sources
- American Cancer Society. Blood Transfusions
- American Cancer Society. Blood Transfusion Side Effects
- American Cancer Society. Low White Blood Cell Counts (Neutropenia)
- American Cancer Society. Low Platelet Count (Thrombocytopenia)
- American Cancer Society. Managing Anemia When You Have Cancer
- National Cancer Institute (NCI). Infection and Neutropenia during Cancer Treatment
- NHS (UK). Blood transfusion
- World Health Organization (WHO). Blood safety and availability
- JAMA, 2023. Red Blood Cell Transfusion: 2023 AABB International Guidelines
- Annals of Internal Medicine, 2015. Platelet transfusion: a clinical practice guideline from the AABB
- Journal of Clinical Oncology, 2018. Platelet Transfusion for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
- British Journal of Haematology, 2020. Guidelines on the use of irradiated blood components
- Journal of Clinical Oncology, 2018. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: ASCO and IDSA Clinical Practice Guideline Update
- Journal of Clinical Oncology, 2020. Antiemetics: ASCO Guideline Update
- New England Journal of Medicine, 2011. The tumor lysis syndrome