Found few literature and no guidelines. Need to know what are the lowest Hb, platelets and neutrophils needed to travel by plane, more than 4 hours, and 10.000 m altitute. Also if there is any type of management directions written for bleeding during the flight, for example.
Please add references, if any.
Hi Ricardo, I have not heard of any problems with Hb, platelet or neutrophil levels associated with airline travel.
If there is a problem, then airline pilots and stewardesses should be showing some hematological symptoms. But as far as I can tell there are none.
Why do you think that immunocompromised patients are at greater risk?
Dear Ricardo,
I am not aware of guidelines for commercial flights. However, I am quite sure that in cases of severe sickness, you should ask the airline whether or not they will transport you.
As for platelets, I would asume that you should have sufficient platelet counts to prevent spontaneous bleeding AND have sufficient platelets in case of injury (luggage falling on your head, whatever...). Therefore, I would think you need at least 50.000/µL, better 80.000/µL. That may be overcautious, but I would not want to suffer from intracranial bleeding on board of a commercial airliner.
As for neutrophils, I think the same rules apply as in everyday live - everything above 3000 cells is wonderful. However, I think you will not present as much, otherwise you would not ask. So 1000 cells should be minimum, as you have to travel with a couple of germs all around you. Maybe a mask would be appropriate, in order to reduce the rate of inhaled noxia.
I cannot speculate on Hb - however, normally pressure in planes can be compared to a height of 2500m (8000 ft) above sea level. So you need a reserve compared to 0m as well...I am sure you can find some information in the references of this article from the German publication in Deutsches Ärzteblatt!
http://www.aerzteblatt.de/archiv/literatur?id=129543#nr24
Thank you Julian. I have just downloaded 2013 IATA Medical Manual, thanks to you.
What's the title of your paper, because I cannot read German?
Dear Ricardo,
the paper was not written by me...but the title in English is stated on the page: "In-flight medical emergencies".
I don't think there are any official guidelines but if the traveller looks obviously sick, he may be deferred for boarding by the plane captain. That is to say you may have 10000 Platelets with no apparent bleeding (I would suggest at least 20000), and no figure for WC, neutropenic patients may travel unless they have fever.
Pour hemoglobin it's different, it's a matter of tolerance in a depressurized plane. Rapatriation Insurances usely ask for a minimum of 10 g or 8 g with oxygen access.
I am not aware of the guidelines. But would imagine since the airlines operate with pressurised air there is no necessarily an additional risk when flying than while a person is on ground at altitudes up to 2000 m above sea level. The usual precautions of traveling with sick persons should be observed including assessment by the right medical officers before planning the trip.
Hi Ricardo,
Hope you remember me.
I think a good idea to get that information could be contact people with a vast experience in immunocompromised people, contact for example people from MD Anderson Cancer Center (Dr. Cortes - Chief of Leukemia) and find out if their institution has any guidance for these kind of patients who need to fly.
My best regards to you.
Sincerely,
I don't think level of Hb, platelets and WBCs matter in air travel.