Natalie Richards
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The importance of blood products during treatment

Natalie Richards
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Updated 07 Mar 2018

I am Natalie White I am a Senior Biomedical Scientist I work in Blood Transfusion and Haematology.

I required 43 units of Blood products during my treatment for Acute Myeloid Leukaemia!

I required 43 units of Blood products during my treatment for acute myeloid leukaemia. Between October 2016 and April 2017, I had 19 units of blood, 14 units of platelets and 10 units of granulocytes, costing the NHS around £15,500!

As a Senior Biomedical Scientist (BMS) in a transfusion laboratory, I have ‘cross matched’ blood products on numerous occasions throughout the last six years of my career for patients on chemotherapy, patients undergoing operations and for emergency haemorrhage situations.

Prior to my own diagnosis, I was always aware of the importance of the blood products issued by the laboratory and the ways this precious resource should be safeguarded with policies and protocols, which allow patients access to the products they require. And to also prevent inappropriate or excessive use of these selflessly donated products. I have received emails directly from the NHS Blood and Transplant service (NHSBT) advising our laboratory of the limited stock levels available and made countless orders for blood products of a certain blood group, only to be offered a suitable alternative as the first choice was simply not available.

Since my diagnosis and the transfusion of blood products, I am no longer able to donate blood. However I encourage my friends and family members to donate on my behalf and I am keeping a record of their donations in order for me to understand  when my debt to the national blood service has been repaid.

The transfusion of red blood cells

My first transfusion was in October 2016 and was essentially given to make me feel well enough to get married prior to my treatment commencing. I received two units of red blood cells four days before my wedding day, in order to boost my Haemoglobin levels and help with the tiredness and breathlessness I had been experiencing. I had been cycling with friends a few weeks previously and couldn’t quite understand why I wasn’t able to keep up! None of us are fitness freaks by any stretch of the imagination but as I had been riding a loan horse at least three times per week prior to this outting, I thought I should at least be able to keep up on a bike ride along the canal! I hadn’t been given my diagnosis at this point, but everything made sense when I later received my full blood count results. My Haemoglobin level was 80 g/L (Hb), when it normally runs at the higher end of normal, around 150 g/L (Hb). It wasn’t until I was aware of my results that I realised how breathless and worn out I'd  become because it was a gradual process. On top of this, at the time of my diagnosis I was working full time, plus on call at weekends, riding a horse multiple times a week and doing an MSc in Biomedical Science by distance learning. I figured feeling tired and drained was normal. 

Read the Bloodwise guide to blood transfusions

My next red cell transfusion was given as a result of blood loss during the process of egg harvesting. This procedure had been offered to me as I was 28 years old with no children and knew it was highly unlikely that I would retain fertility after chemotherapy. Egg harvesting is normally a simple procedure where patients inject hormones into their stomach for around one week to help stimulate egg overproduction and then attend hospital for the eggs to be removed and frozen for future use. I had to attend the hospital for an appointment to see how the egg simulation was progressing on my wedding day!! The hospital gave me the earliest possible appointment and I booked the church a little later than I originally planned telling my future Husband not to be worried if I leave him standing at the alter for a while. The day of the egg harvesting procedure seemed to go well and I was sent home just hours after I'd woken from the anaesthetic. Although I felt sore I thought this was expected. It wasn’t until later that evening that the pain began to worsen and became unbearable I had to ask my husband to take me back to the hospital. I expected to be prescribed some strong painkillers and then sent home but instead I had an ultrasound scan which showed excessive bleeding. I remained in hospital for almost two weeks until the blood was reabsorbed and the pain subsided as surgery was considered too risky with my underlining condition. My haemoglobin level fell substantially due to both the blood loss and my leukaemia and consequently I required two units of red blood cells.

The remaining 16 units of red blood cells were transfused after my chemotherapy treatment had commenced. Chemotherapy drugs affect fast-dividing normal cells as well as the cancerous cells. As a side effect of chemotherapy treatment, the fast dividing blood cells may be killed and the patient may require a blood transfusion. White cells, red cells and platelets are all affected, leaving the patient susceptible to infections and bleeding. Red cells are given to treat anaemia, platelets to prevent bleeding and white cell donations are rarely used but can be effective in immunocompromised patients with infection following chemotherapy. I had three cycles of chemotherapy and was transfused the 16 units of red blood cells over the three cycles. At one point my haemoglobin level fell to 60 g/L. It is important to keep Hb levels above threshold levels in order to keep the body supplied with enough oxygen and to prevent cardiac arrest.

The transfusion of platelets

I practice in a different hospital from the one I was treated in. The protocols and procedures surrounding blood products, their issue and use are very similar as they both follow the British Committee for standards in Haematology guidelines but they are not the same. I don’t remember my first platelet transfusion, probably because I was so unwell. It would have been given during my first chemotherapy cycle as my platelet count had fallen due to the treatment prescribed. I do remember the platelet transfusion ordered during my first cycle of chemotherapy which was challenged by the blood transfusion laboratory. I myself have challenged Dr on countless occasions over the last six years who have ordered excessive amounts of blood products in comparison to our laboratories maximum blood order schedule or have ordered a blood transfusion for a patient with iron deficiency anaemia, when an iron infusion or treatment with iron tablets would be more appropriate, as a Biomedical Scientist working in Blood transfusion that is simply part of the job, we safeguard the products we hold, protect them from inappropriate use as far as possible without refusing products at a doctors request. As a patient I experienced the flip side to this. I had an infected Hickman line which needed to be removed, but I also had a low platelet count and was susceptible to bleeding. The Dr who reviewed my morning blood counts had ordered for a unit of platelets to be transfused prior to the removal of the line, the BCSH guidelines indicate minimum platelet counts required for set procedures in patients. My platelet count was just below the threshold for removal and the laboratory challenged the decision to transfuse, the Doctor agreed with the laboratory and the request for platelets was cancelled, I was very distressed as a result of this decision. As a BMS I know the BCSH guidelines are ‘guidelines’ I also know that had my full blood count been run again the analyser would produce a report very similar to the first but not identical, for example I may have 60 x10 9/L platelets on this report but 58 x10 9/L platelets on the report first produced, a difference of no clinical significance.  My count was so close to the threshold that the difference was not considered to be significant, but it was to me, as the patient lying in the hospital bed about to have a line removed from one of the veins close to my heart I was bothered by the fact that my count was not just 2 X109/L higher and I was concerned and anxious about bleeding. At first I refused for my line to be removed, I blamed the laboratory for cost cutting and being heartless. I was very unwell with a very nasty infection in my liver at the time, I had no white blood cells of my own to help me fight the infection and was receiving regular red cell transfusions to help me maintain my haemoglobin levels. I came to my senses a few hours later and agreed for the line to be removed without the platelets as it was thought to be an additional source of infection, I requested for a cannula to be inserted prior to removal of my line so I had a line ready for use in case I did bleed. The Hickman line was removed with no issues, the platelets had not been necessary, most likely they were used for another patient who needed them, the laboratory had prevented me from being exposed to a blood product that I didn’t need, prevented the need to reorder a another bag to replace them had I been given them, and saved around £200. Had I bled during the removal of the line the platelets would have been released without question.

My next ‘platelet problem’ came during my second chemotherapy cycle in which I developed petechea and required platelet support. My full blood count showed that my platelet count had fallen to 8 x109/L (Normal range: 150 x10 9/L – 450 x10 9/L) leaving me at risk of spontaneous bleeding. I had received several units of platelets but my platelet count was not incrementing and I required platelets on a daily basis. I was group A Rh D Positive prior to my stem cell transplant (My sister, my donor is also A Rh D Positive, so I still will be), and so ideally required A Rh D positive donor platelets for transfusion. I am aware from my own experiences with blood products that other blood groups are suitable and have an order of preference with group O usually being the third choice usually reserved for Group O patients only at the trust in which I work, this is to minimise haemolysis and maximise increment count. Although Group O platelets may be given to a non-group O patient to prevent wastage or in an urgent situation when an alternative cannot be provided I have been trained to always endeavour to order group matched platelets if time permits. So when my nurse came to my bedside one afternoon with a bag of Group O platelets to transfuse into me i questioned why, I was clinically stable, I required platelets that day but could wait for them to be ordered in from the local blood centre so why was I being given the third choice? My nursing team were very professional and listened to my concerns they called the blood bank for me expressed my views and returned the platelets, the blood transfusion laboratory issued Group A and I was more at ease with the transfusion.  This situation occurred again a few days later as group A platelets were again not available, after further talks with the blood transfusion laboratory and my own colleagues I discovered the differences in the policies between the trust in which I work and the trust in which I was treated. I worried about them at first as it was foreign to me, but now respect the policy of the treatment hospital as it strives to reduce wastage, an undesirable outcome for donated blood products.  The remaining twelve units of platelets was given in support after chemotherapy to prevent bleeding during Hickman line reinsertion, spontaneous bleeding and bleeding from minor trauma once sent home.

The transfusion of granulocytes

The morning in which I was told I was due to receive a granulocyte infusion I will never forget, I was shocked and scared, in the previous six years I had worked as a biomedical scientist in a transfusion laboratory neither I nor any of my colleagues had ever issued granulocytes to a patient, although I work for a smaller trust from the one in which I was treated in and so I figured my treatment hospital laboratory must issue them all the time. It wasn’t until I met with a colleague who had transferred from my workplace to my treatment hospital that I realised that the issue of granulocytes was an extremely rare occurrence in this trust too. I was transfused with 10 units of granulocytes in total, all during my first chemotherapy cycle, each unit costing around £1000! Transfusion was given despite my raised temperature and rash (indicators of a transfusion reaction) as I was just so unwell. Every time I saw the unit of white cells I would panic as I worried about reacting to them and becoming yet more ill. In hindsight I think the white cells (or rather their donors) probably should take most of the credit for saving my life during my first chemotherapy cycle. Essentially I had a liver infection which had occurred following the egg harvesting procedure, I was unaware as were my doctors of the liver abscess, I was subjected to chemotoxic drugs due to my leukaemia which attacked my normal functioning blood cells too and left me with no immune fighting white blood cells. The liver infection was then able to ‘take hold’ of me and I become extremely unwell, but by borrowing the immune system of blood donors via the granulocyte transfusion my doctors were able to bridge to gap until my own immune system and blood counts recovered from the chemotherapy and the liver infection could be cleared.

I owe a lot to blood donors, not only my job but more importantly my life!




Funny this popped up today, this morning I was trying to think about how many transfusions and platelets I had when I was ill. I was thinking I should write a blog as today is my 5th anniversary of my bone marrow transplant. I'm am now very well but had spent about an hour this morning remembering everything I went through. I reckon I had over 20 blood transfusions of 2 or 3 units of blood and about 5 lots of platelets. Words fail me as to how important it is for people to donate, I never did as I was 'scared' and now I can't as funnily enough, no one wants blood from someone who's had blood cancer. So for everyone who does, thank you so much. X



Thank you so, so much for this blog which is absolutely brilliant and provides a brilliant oversight of just how important blood and platelets are to patients. Like Hannah I can't remember exactly how many I received during my treatment but they made an enormous difference.

So, so proud of how you're doing after your transplant and am frankly in awe of how much get up and go you've got already. Don't rush too much as you've still got your whole life ahead of you.


Massive congratulations on being 5 years post transplant. That's absolutely wonderful news and a significant milestone.

I hope you did something nice to celebrate and couldn't agree more about how important blood and platelet transfusions are. My transplant was 13 years ago now and I can't remember for the life of me how many transfusions I had but I know they were multiple and I'm so glad that Natalie has written such a great blog on this.

Speaking of blogs, I'd love to read a blog about your experiences and how far you've come since your transplant and think this would be so valuable to patients like Natalie who are still some way further back in their 'journeys'.


Natalie, your blog was so interesting and really raises the need for blood product resources and stocks.  Thanks for blogging and take lots of special care of yourself.


Thanks Hannah and Andy. Tbh i only could only recall about half the transfusions i actually had and its wasnt untill i asked a collegue to confirm i realised i had had far more than i remembered. Really hoping this blog will continue to inspire people to donate.


Thanks Erica!