TME 76: Understanding the Impact of Cancer on the Body

Cancer takes a heavy toll on the body. It affects the bone marrow, which is the factory that produces:

• Red blood cells (oxygen carriers)

• Platelets (clotting/bleeding control)

• White blood cells (immunity/defense system)

  
  

The Damage to Bone Marrow

Two main factors can damage this factory:

1. Cancer itself (especially leukemia, lymphoma, and marrow-infiltrating cancers)

2. Chemotherapy, which targets fast-dividing cells—including healthy marrow cells

   
   

This leads to:

• Low hemoglobin

• Low platelets

• Low white cell counts

  
  

And that is exactly why transfusion support becomes necessary.

Understanding Hemoglobin and Platelet Drops in Cancer Treatment

Chemotherapy drugs are cytotoxic. This means they damage or destroy cells—especially cells that divide rapidly.

The Bone Marrow's Vulnerability

The bone marrow has some of the fastest-dividing cells in the entire body. When chemotherapy hits:

• Red cells cannot be produced → severe fatigue, breathlessness

• Platelets drop → bleeding risk

• WBCs drop → infections skyrocket

  
  

This is predictable. It’s not a failure of therapy. It’s a known side effect, and transfusion is the support system that carries patients through treatment.

Essential Blood Components for Cancer Patients

A. Packed Red Blood Cells (PRBCs)

Function: Restore oxygen-carrying capacity so patients can breathe easier and tolerate chemotherapy.

B. Platelets

Function: Prevent or stop bleeding. Cancer patients may need platelets multiple times per week during certain cycles.

C. Fresh Frozen Plasma (FFP)

Function: Replaces clotting factors when the liver is affected or bleeding is present.

D. Cryoprecipitate

Function: Restores fibrinogen in special bleeding disorders or post-chemotherapy conditions.

Not all cancers require all components, but red cells and platelets form the backbone of treatment.

Understanding White Blood Cells (WBCs) and the Importance of Leukoreduction

To understand leukoreduced blood, we need to understand what WBCs do.

What are WBCs?

They are the body’s soldiers. There are different types:

• Neutrophils → fight bacteria

• Lymphocytes → coordinate immunity, produce antibodies

• Monocytes → clean up debris

• Eosinophils & basophils → respond to allergy/parasitic infections

  
  

Each type is part of a highly coordinated defense network.

Challenges with WBCs in Transfusion

When donor WBCs enter another person's body:

1. They can trigger fevers

2. They can attack the patient’s tissues

3. They can carry certain viruses

4. They increase the risk of forming antibodies

5. They can cause severe immune reactions in immunocompromised cancer patients

   
   

This is where leukoreduction becomes life-saving.

Blood Modifications for Cancer Patients

Cancer patients often have weakened immunity and inflamed immune systems. Therefore, we “modify” blood to make it safer. Let’s break down each type simply, with science + how it’s actually done in the blood bank.

A. Leukoreduction: Removing White Blood Cells

What it does: Reduces WBC count in a blood unit by 99.9%.

Why cancer patients need it:

• Prevents fever after transfusion

• Reduces infections from donor WBCs

• Lowers chances of alloimmunization

• Reduces inflammation

• Protects immunocompromised patients

  
  

How leukoreduction is done: The blood bag is passed through a special micropore filter. This filter traps WBCs but lets red cells or platelets flow through smoothly. There are two methods:

1. Pre-storage leukoreduction (best) – done inside the blood bank within 24 hours

2. Bedside leukoreduction – done using inline filters during transfusion

   
   

B. Irradiation: Preventing Donor Cells From Attacking the Patient

What it does: Stops donor lymphocytes from multiplying.

Why cancer/bone marrow transplant patients need it: Prevent Transfusion-Associated Graft vs Host Disease (TA-GvHD)—a rare but often deadly reaction where donor WBCs attack the patient.

How irradiation is done: The blood bag is placed inside an irradiator machine (gamma, X-ray, or linear accelerator). The machine exposes the blood to a specific dose—usually 25–50 Gray. This inactivates donor lymphocytes but keeps the blood usable.

C. Apheresis: Collecting Only What the Patient Needs

What it means: Instead of collecting whole blood and separating components later, a donor is connected to an apheresis machine. The machine:

• Takes blood

• Separates the needed part (platelets, plasma, granulocytes)

• Returns the rest back to the donor

  
  

Why cancer patients benefit:

• Fewer donor exposures

• Higher-quality platelets

• Custom quantity for each patient

• Safer for transplant cases

  
  

Apheresis platelets are the gold standard for leukemia and post-transplant care.

D. Washed Red Cells / Washed Platelets

What it does: Removes donor plasma proteins that cause allergic reactions.

How washing is done: The blood unit is connected to a centrifuge system that:

• Spins it

• Removes plasma

• Adds saline

• Repeats the process

  
  

This method is used for patients with:

• Severe allergic reactions

• IgA deficiency

• Prior anaphylaxis

  
  

Special Requirements for Bone Marrow Transplant (BMT) Patients

Before a transplant, patients undergo conditioning therapy—very high-dose chemotherapy or radiation that wipes out their bone marrow. During this phase, they need:

• Irradiated PRBCs

• Irradiated platelets

• Leukoreduced components

• Often apheresis platelets

• Sometimes HLA-matched platelets

  
  

After the transplant, they remain dependent on transfusions until the graft starts producing new cells. Blood is not just supportive—it is survival itself during this period.

Can Cancer Patients Receive Normal Blood Without Modification?

They can, but not recommended. Unmodified blood increases risks of:

• Fever

• Inflammation

• Viral transmission

• Alloimmunization

• Delayed chemo cycles

• TA-GvHD

• Infections

  
  

Modified blood is not a luxury—it is the standard of safe care.

The Importance of Understanding Blood Transfusion in Cancer Care

When families understand why transfusions are needed and how blood is made safer, their anxiety drops. A calm mind follows predictable explanations. When fear reduces, treatment acceptance improves. This is psychology, not medicine. Understanding gives strength.

The Hidden Workforce Behind Cancer Care

One cancer patient may require:

• 10–20 donors per month during chemotherapy

• Over 40 donors per month if undergoing a transplant

  
  

Behind every cancer survivor is an entire unseen team:

• Voluntary donors

• Apheresis specialists

• Transfusion medicine doctors

• Technicians

• Counselors

• Nurses

• Lab scientists

  
  

Cancer care and blood banks are two halves of the same system.

Actionable Takeaways for Patients, Families & Readers

✔ Ask your doctor if you need modified components

Especially irradiated or leukoreduced units.

✔ Inform the blood bank early if a transplant is scheduled

They need preparation time.

✔ Encourage regular voluntary platelet donation

Platelets expire in 5 days—this is a constant need.

✔ Understand that count drops are expected

Don’t panic. They can be managed with timely transfusion.

✔ Share this knowledge

More awareness = more donors = more cancer patients supported.

If this guide helped you understand the science behind blood transfusion in cancer, please:

1. Share this article with caregivers or medical students.

This knowledge empowers people.

2. Encourage someone to donate blood or platelets this month.

One donor can support multiple cancer patients.

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