During and after your transfusion

Your appointment takes place in the haematology day unit, at Guy’s Hospital, unless you are told otherwise.

The exchange transfusion process can take 2 to 3 hours on the machine. This will depend on your medical history and how much blood will be used during the procedure. You should expect to be in the unit for the whole day.

Sometimes the exchange transfusion will start late. This is usually because a patient has had difficulty getting to hospital in time, or rarely, if the machine is being used for an emergency procedure.

On the day of your transfusion 

When you come to the unit for your transfusion, you should:

• bring your regular daytime medicine, including your painkillers. We do not give injectable painkillers before or during routine exchange procedures. We suggest that you bring your normal oral painkillers from home when you attend your EBT.
• arrive before 10am on the date given in your letter. It is important that you arrive on time to avoid a cancellation or the need to stay in hospital overnight to complete the exchange the following day.
• wear something comfortable. 

You might be in the unit all day, so you might want to bring something to eat (that does not need heating up).

You might also want to bring something to keep you entertained, such as a book or laptop.

We might ask you to turn your mobile phone off during your transfusion. 

Do not bring children with you, as the day unit is an unsafe environment for children. We do not have any childcare facilities.

During your transfusion

Your line will be attached to a machine called a cell separator. Connecting the line is not painful. The bag of blood with your details on (name, date of birth, hospital number) will be carefully checked and then the EBT will start.

Blood is taken out of a large vein in your arm into the cell separator. Inside the machine, the blood is spun very quickly so that the blood separates into layers.

The separated plasma, alongside the donated blood, return to you through a vein in your other arm. Your own red cells will travel up into a collection or waste bag. Only about 180ml (a small glass) of blood will be outside of your body at any time.

The nurses will monitor you (check your blood pressure, pulse, temperature and oxygen level regularly) and your machine throughout the EBT.

During the exchange, you can:

• sit up or lie down, but you cannot move off the bed. This is because the lines attached to you are not long enough for you to move around, and because you may become light headed
• read and write
• eat and drink
• use the toilet, but you will need to use a bed pan or bottle

After having an EBT

When the exchange is finished, blood is taken from your line (cannula, Port-a-Cath or femoral line) so we can see how much of the sickle haemoglobin is left in your blood.

After the exchange, we recommend that you go home and rest for the evening. You can return to work the next day if you feel well enough.

Does the EBT always work?

Most patients selected for a long-term transfusion programme have severe sickle cell disease (SCD). The exchange transfusion tries to reduce the number of sickle cells in the blood as much as possible, but it can’t make them disappear.  It also can’t reverse any damage that has already happened, such as complications from a stroke, bone damage, or visual loss associated with SCD. This means that sometimes problems can happen to people even though they are on an exchange transfusion programme.

You will still have an increased risk of infection and the transfusion won’t affect any chronic bone damage that has happened already. However, It is important to remember that EBT can reduce the chances of new problems happening. 

More information 

NHS Blood and Transplant provide information on blood donation and how blood is used.

www.blood.co.uk

The NHS website has information about sickle cell disease.