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Introduction
A blood transfusion is the transfer of blood or blood products from one
person (donor) into another person's bloodstream (recipient). This is usually
done as a life saving maneuver to replace blood cells or blood products lost
through severe bleeding, during surgery when blood loss occurs or to
increase the blood count in an anemic patient. The following material is
provided to all patients and/or their family members regarding blood
transfusions and the use of blood products. Although in most situations the
likelihood of a blood transfusion associated with surgery is uncommon, at
times patients may require blood products. You are encouraged to discuss
your particular risk of transfusion with your doctor.
Your options may be limited by time and health factors, so it is important to
begin carrying out your decision as soon as possible. For example, if friends
or family members are donating blood for a patient (directed donors), their
blood should be drawn at least two working days prior to the anticipated
need to allow adequate time for testing and labeling. You are also
encouraged to check with your insurance company for their reimbursement
policy.
The safest blood product is your own, so if a transfusion is likely, this is your
lowest risk choice. Unfortunately this option is usually only practical when
preparing for elective surgery. In most other instances the patient can not
donate their own blood due to the acute nature of the need for blood.
Although you have the right to refuse a blood transfusion, this decision may
hold life-threatening consequences. If you are a parent deciding for your
child, you as the parent or guardian must understand that in a lifethreatening situation your doctors will act in your child's best interest to
insure your child's health and well being in accordance with standards of
medical care regardless of religious beliefs. Please carefully review this
material and decide with your doctor which option(s) you prefer.
To assure a safe transfusion make sure your healthcare provider who starts
the transfusion verifies your name and matches it to the blood that is going
to be transfused.
Apheresis - donating you own platelets and plasma. Before surgery, your
platelets and plasma, which help stop bleeding, are withdrawn, filtered and
returned to you when you need it later. This can be done only for elective
surgeries. This process may eliminate the need for donor platelets and
plasma, especially in high blood-loss procedures. The disadvantage of this
process is that some medical conditions may prevent apheresis, and in
actual practice it has limited applications.
Donor Blood (Using someone else's blood)
All donor blood is tested for safety making its risks very small, but no
screening program is perfect and risks, such as contraction of the hepatitis
virus or other infectious disease still exist.
Volunteer blood - blood collected from the community blood supply (blood
banks). This has the advantage of being readily available, and can be lifesaving when your own blood is not available. The disadvantage is that there
is a risk of disease transmission, such as hepatitis or AIDS, and allergic
reactions.
Designated donor blood - blood is collected from the donors you select.
You can select people with your own blood type who you feel are safe donors.
Like volunteer blood, there is still a risk of disease transmission, such as
hepatitis and AIDS, and allergic reactions. This process usually requires
several days for advanced donation. It may not necessarily be safer than
volunteer donor blood.
What is it?
Blood transfusion is the process of transferring blood or a blood component
from one person, the donor, to another person, the recipient.
Who needs this procedure?
Blood transfusions are given to increase the blood's ability to carry oxygen,
to restore the body's blood volume when there has been a great blood loss,
to improve the blood's clotting ability, and to improve a recipient's immunity
to infection. Depending upon the recipient's needs, a doctor may order a
whole blood transfusion, or a blood component. Blood components include
red blood cells, white blood cells, platelets, immunoglobulins, or fresh frozen
plasma, which is the liquid part of the blood. Whole blood is usually used
with patients who have lost a lot of blood, and to make sure the body's
tissues are receiving enough oxygen. Red blood cells restore the blood's
ability to carry oxygen, such as in patients who are bleeding or have anemia.
White blood cells are given to patients with life-threatening infections that
reduce the white blood cell count. Platelets are often given to patients with
blood clotting disorders, such as hemophilia or von Willebrand's disease.
Plasma also helps with blood clotting, and is often transfused in patients with
liver failure. Immunoglobulins are the disease fighting components of blood
and are also given to build up immunity, especially in patients who have
been exposed to an infectious disease or whose antibody levels are low, such
as those with AIDS.
How do I prepare for this procedure?
If you know you will be undergoing surgery, you may want to donate your
own blood a month before your surgery. This is called an autologous
transfusion, and the blood you donate is stored at the hospital for your use
only. If you need a transfusion during or after surgery, your own blood will be
used. Or, you could ask a friend or family member with the same blood type
to donate blood specifically for you. This is called a direct donation. Many
people feel more comfortable knowing the source of the blood for a
transfusion. However, the medical community has adopted stringent
screening methods to ensure blood transfusions are extremely safe. Blood
donors must answer questions about their general health, lifestyle, and any
medical conditions that might disqualify them as donors. All donated blood is
carefully checked for viral hepatitis, AIDS, syphilis, and other viruses. No
blood is used until all test results have shown that it is safe. If you have had
allergic reactions to previous transfusions, you should make sure your doctor
is aware of this. Treatments are available so transfusions can be given to
people who have had allergic reactions.
How is this procedure performed?
All donated blood is classified by type, either A, B, AB, or O, and as RHpositive or RH-negative. To protect the recipient, the blood is matched to his
or her blood type. Before starting the transfusion, the healthcare professional
cross-matches the donor blood by mixing a drop of it with the recipient's to
make sure they are compatible. The healthcare professional will also doublecheck that the blood is intended for the recipient. Then, the donor blood is
given slowly, through an intravenous (IV) line directly into the veins. Blood
transfusions are given in units, with one standard unit of blood equaling
about one pint. During the transfusion, medical personnel watch the patient
closely for any adverse reactions. When the transfusion is complete, a
compress bandage is placed over the area where the needle had been
inserted.
People with heart disease are given transfusions even more slowly to avoid
overloading the body with fluid. People with serious diseases that haven't
responded to other treatments might benefit from a transfusion method
called hemapheresis. Hemapheresis is a process that purifies the blood by
removing blood from the patient, cleaning the harmful components from it,
then returning the purified blood to the patient. Cytapheresis is a type of
hemapheresis that removes excess amounts of certain blood cells. It might
be used to treat conditions such as polycythemia, leukemia, and
thrombocytosis. Another type of hemapheresis called plasmapheresis
removes harmful substances from the plasma. This treatment might be used
for patients with Guillain-Barre syndrome and myasthenia gravis.
What can I expect after the procedure?
After a blood transfusion, you will be carefully monitored for any adverse
reactions. An allergic reaction is indicated by swelling, rash, itchiness,
dizziness, fever, and headache. When blood is mismatched, the recipient's
blood reacts to the transfused red blood cells and destroys them. This is
called a homolytic reaction. Symptoms may include general anxiety or
discomfort, then breathing difficulty, flushing, a feeling of pressure in the
chest, and severe back pain. It is rare for these types of reactions to be life
threatening.
Definition
A hemolytic transfusion reaction is a serious problem that occurs after a
patient receives a transfusion of blood. The red blood cells that were given to
the patient are destroyed by the patient's own immune system.
Alternative Names
Blood transfusion reaction
The immune system normally can tell its own blood cells from blood cells
from another person. If other blood cells enter your body, your immune
system may make antibodies again them. These antibodies will work to
destroy the blood cells that the body does not recognize. For example, a
person with type A blood makes antibodies against type B blood cells.
Another way blood cells may be classified is by Rh factors. People who have
Rh factors in their blood are called "Rh positive." People without these factors
are called "Rh negative." Rh negative people form antibodies against Rh
factor if they receive Rh positive blood.
There are also other factors to identify blood cells, in addition to ABO and Rh.
Blood that you receive in a transfusion must be compatible. Being
compatible means that your body will not form antibodies against the blood
you receive. Blood transfusion between compatible groups (such as O+ to
O+) usually causes no problem. Blood transfusion between incompatible
groups (such as A+ to O-) causes an immune response. This can lead to a
very serious transfusion reaction. The immune system attacks the donated
blood cells, causing them to burst.
Today, all blood is carefully screened. Modern lab methods and many checks
have helped make these transfusion reactions very rare.
Symptoms
Bloody urine
Chills
Fainting or dizziness
Fever
Flank pain or back pain
Rash
Symptoms of transfusion reaction usually appear during or right after the
transfusion. Sometimes, they may develop after several days (delayed
reaction).
Medical history interview All blood donors are asked questions about
their medical history to help determine if they can safely donate blood
without experiencing any negative health effects [1]. During the donation,
one unit of blood (approximately 500 mL or 17 fluid ounces) is removed.
APHERESIS DONATION
A technology called apheresis has made it possible to collect specific
components of blood during the donation procedure. Apheresis is used to
selectively collect red blood cells, platelets (blood components that play an
important role in clotting), plasma, and granulocytes (a type of infectionfighting white blood cell).
Bacterial infection Bacteria can get into donated blood if a donor has a
bacterial infection, if bacteria on the skin gets into the blood from the needle
stick, or if there is a skin infection near the location where the blood is
drawn. To reduce the likelihood of bacterial contamination of blood, the skin
around the site is carefully examined and cleaned before the needle is
inserted.
Donors who have a fever, who do not feel well, or who are taking oral
antibiotics (except for acne) are not permitted to donate blood. These
restrictions also apply to individuals who are banking blood for their own use
(see 'Autologous blood donation' below).
Other medical conditions In order to protect the recipient against noninfectious complications, the donor is evaluated for certain medical
conditions before blood donation.
Donors who have had cancer of a solid organ or tissue (such as the lung,
liver, breast) are permitted to donate if they have been symptom-free and
cancer-free for a defined period of time, usually two to five years.
Donors who have had blood cancers (such as leukemia or lymphoma) are
permanently disqualified from donating.
Donors who have had a superficial cancer that has been completely removed
by surgery (such as basal cell cancer of the skin or early cervical cancer) can
donate blood without any waiting period.
Donors who have taken isotretinoin and finasteride are asked to wait one
month after the last dose before donating blood, donors who have taken
dutasteride are asked to wait six months, and donors who have taken
acitretin are asked to wait three years. Individuals who have taken etretinate
are permanently disqualified from donating blood.
People who took aspirin or aspirin-containing medications within the previous
48 hours are allowed to donate whole blood but are not allowed to donate
platelets by apheresis. People who took warfarin (Coumadin) are generally
not allowed to donate blood for approximately 7 days after the last dose. The
reason for this is that this blood does not contain sufficient quantities of
clotting factor.
Laboratory testing of donated blood After a unit of blood has been
donated, the blood is tested in a laboratory for infectious diseases that can
be transmitted by blood transfusion. These include tests for HIV, hepatitis B,
hepatitis C, human T-lymphotropic virus (HTLV), West Nile virus, syphilis, and
in most areas, Chagas' disease. (See "Patient information: West Nile virus
infection".)
Confidential unit exclusion (CUE) The confidential unit exclusion (CUE)
process allows someone who has donated blood to confidentially indicate
that his or her blood should not be given to others. This process protects
individuals who feel pressured to donate at the workplace or during
community blood drives. Donors are asked to place a bar code sticker on
their donation form, indicating if their blood should be used. This is done
after the interview, but before donation. This procedure is used by some, but
not all, US blood banks.
Registry of deferred donors A registry of deferred donors contains
names of individuals who have been disqualified from blood donation in the
past. Some donors in the registry have infectious diseases such as hepatitis
B or HIV infection. Theoretically, it is possible that an individual with one of
these diseases could have a positive test result at one time but negative test
results at a later time.
Other donors in the registry have provided information in the past that
disqualified them from blood donation. A donor's name is usually checked
against this registry before and after donation. The reason for the deferral is
not usually available to staff at the collection facility.
Telephone callbacks After donating blood, donors are given a phone
number so that they can call the donation center to report any factors that
may affect the use of their blood or to report symptoms of infections in the
first days after donating (such as symptoms of upper respiratory tract
infection or gastrointestinal illness). Such reports will be evaluated and the
unit of blood may be destroyed.
RISK OF INFECTION FROM A TRANSFUSION
Safety measures, such as improved screening tests, have dramatically
reduced the risk of acquiring a viral infection from a blood transfusion.
Recent estimates suggest the following risks of developing certain infections
after receiving a unit of blood:
2.
Before the transfusion begins, the patient must sign a consent form.
The doctor will then order the patient to take medications, such as
antihistamines and acetaminophen, before the transfusion. Before the
transfusion begins, two nurses will check the patient's identity. The nurse
performing the transfusion will then insert an intravenous line into the
patient's arm.
Nurse's Responsibility During Procedure
3.
Blood transfusions are relatively simple procedures that can up to 11/2 to two hours, depending on the amount of units being transfused into
the patient. Generally, most transfusions require at least two to three
units. The patient is allowed to eat and drink during the procedure and is
able to use the bathroom with assistance from the nurse.
You can expect that your doctor will order a blood specimen to
confirm your blood type and to check compatibility with the
donor unit. Compatibility testing (also referred to as cross
matching ) is done even if you have donated your own
(autologous) blood.
Check with your doctor about how much time to plan for your
blood transfusion procedure. Each unit of blood usually
transfuses over 1 to 2 hours. Some transfusions are for 2-3
units. You may be here for several hours depending on what your
The nurse will ask you to sign a consent form verifying that you
understand and agree to the procedure as explained by your
doctor.
Your doctor may order medication for you to take prior to the
transfusion. The nurse will explain the reason and action of the
medications.
You may eat and drink during this procedure. With the assistance
of a nurse, you may get up and go to the bathroom.
Shortness of breath
Itching/hives, rash
Nausea
Feelings of apprehension
Tingling or numbness