Blood Transfusions: Knowing Your OptionsBlood transfusions save millions of lives each year and are a critical part of everyday medical procedures. If there is a possibility you will receive a blood transfusion, it is important that you understand your options in order to make a timely and informed decision. If you fall into one of the following categories you may need to replace blood taken for tests or may need a transfusion: organ transplants, cancer therapy, heart and other invasive surgeries, support for patients with blood disorders, resuscitation of trauma victims, and preterm babies who may not produce enough red blood cells as quickly as needed for rapid growth. This brochure will:
- Explain the options available to you should you or a loved one require a blood transfusion
- Help you ask questions and get the information you need
- Help you understand the risks and benefits of a blood transfusion
- Help you request alternatives that may reduce the risks from a blood transfusion
Why Would a Blood Transfusion Be Recommended?
- You may require a transfusion to replace blood lost during surgery or in an accident.
- If receiving chemotherapy, your bone marrow may be temporarily unable to produce new blood cells.
- The symptoms from anemia may make a transfusion necessary.
Where Does Blood for a Transfusion Originate?Nearly all blood donations, in the U.S. and other developed nations, are from volunteer donors who donate blood through a network of blood centers and hospital blood banks. Donors are eligible to give whole blood up to five times a year, and can donate some blood components, such as platelets more frequently.
U.S. Facts About Blood1Most Americans will require a blood transfusion at some point in their lives.
Each year approximately 8 million volunteer donors give about 15 million blood donations.
About 12 million units of red blood cells and whole blood, 8 million platelet units and 3 million plasma units are transfused annually.
Blood and Blood ComponentsMost blood collected for transfusion is separated into its components: red blood cells, platelets, and plasma. Your medical situation will determine which blood component you may need.
- Red blood cells (RBCs): RBCs are the cells that give your blood its red color. RBCs carry oxygen from the lungs to your body’s tissues and take carbon dioxide back to your lungs to be exhaled.
- Platelets (PLTs): PLTs are small, colorless cell fragments in your blood whose main function is to stop bleeding by promoting clotting. An average of four to six units of platelets from whole blood donations (or one hemapheresis donation) is needed to meet the needs of a single transfusion.
- Plasma: Plasma is the liquid portion of your blood. Plasma transports water and nutrients to your body’s tissues. It also contains many proteins that help the blood to clot and fight disease.
Is It Safe to Get a Blood Transfusion?All medical therapy involves some degree of risk. Many patients and their families are concerned about the risk of contracting a disease such as hepatitis, AIDS, or a bacterial infection through a transfusion. The safety of the blood supply is a shared responsibility of many organizations, including community blood banks and the federal government. Donors are carefully screened for a history which suggests the potential for transmission of a disease. Only a person who meets the standard qualifications and receives a “clean bill of health” is permitted to give blood. In addition, while being processed the blood goes through extensive testing for various infectious disease markers including HIV and hepatitis. In almost every case, the lifesaving benefits of receiving a blood transfusion outweigh the risk of contracting an infectious disease. The risk of contracting HIV from a blood transfusion is currently one in 1,900,0002 blood supply has never been safer, blood transfusions are not risk-free. If your doctor recommends a transfusion, you will need to decide if you want to have the transfusion and should have the options explained in order to provide informed consent prior to the transfusion. Your physician can advise you about the adverse consequences of a transfusion, its benefits and how to reduce the risks of adverse consequences including infection.
What Are the Risks Associated with Blood from Volunteer Donors Beyond HIV?Most of the blood transfused is allogeneic blood from others. Allogeneic blood is compatible with, but different from your own, which increases the risk of an undesired reaction. Ninety percent of transfusion reactions are caused by the donor’s white blood cells or leukocytes transfused along with the red cells or platelets. Leukocytes (or white cells) carry certain viruses and can suppress the immune systems of patients, increasing their risk of infections after surgery. You have the right to ask for filtered (or leukocyte reduced) blood and platelet transfusions to protect yourself from these contaminating donor white cells. Filtered, leukocyte reduced blood has been shown to reduce infectious disease transmission, immune sensitivity reactions and protect surgical patients from postoperative bacterial infections. (Source: Cervia JS, Wenz B, Ortolano GA. Leukocyte reduction’s role in the attenuation of infection rates among transfusion recipients. Clin Infec Dis 2007; 45(8):1008-1013).
White Blood Cells or LeukocytesWhite cells or leukocytes fight disease and maintain immune function in your blood. In general, white cells in a blood transfusion serve no purpose, but are transfused along with the red blood cells, platelets or plasma. These unnecessary passengers can carry viruses, immune suppress patients and release toxic substances.
White Blood Cell Associated VirusesCytomegalovirus (CMV)
Human Herpes Virus Type 8 (HHV-8)
Human T-Lymphotrophic Virus Type I & II (HTLV I & II)
HIV (leukocyte and plasma associated)
If Nearly All Blood Comes From Volunteers, Why Is There a Charge?While blood is freely donated by volunteers, blood centers charge a fee to hospitals to cover the costs of collecting, testing, processing and distributing the blood. These “service fees” also apply when you’re donating blood for your own use. Hospitals also charge a fee for laboratory work, necessary to ensure that the donated blood matches your blood type and for the transfusion procedure.
What Are Blood Substitutes and When Will They Be Available?Despite promising research, a true substitute for blood cells (red cells and platelets) may not be routinely available for many years. More likely, blood transfusions will continue to become safer because of improved blood donor screening and filtration. In addition, scientists are exploring new technologies to sterilize and eliminate infectious agents from blood transfusion. New drugs and medical techniques can sometimes significantly reduce or eliminate the need for blood transfusion. For example, most surgeries today require far less blood than just a few years ago. In another example, patients on kidney dialysis who previously needed monthly blood transfusions, now can take a drug (recombinant human erythropoietin) that promotes their own red cell production. This may eliminate or reduce their need for blood transfusion.
Frequency of White Cell Associated Adverse Transfusion Reactions
- Red Cell Transfusions 0.5 – 6%
- Platelet Transfusions 20% – 30%
Can Blood I Donate Be Used for My Transfusion?Using your own blood, an autologous donation, significantly reduces the risk of a reaction or disease. You can donate blood for up to six weeks before your surgery. Doctors may also collect your blood at the beginning of the surgery and return it to you at the end of the operation. Another method used to replace blood loss with your own blood is intraoperative autologous transfusion (IAT). This procedure allows the doctors in the operating room to recover blood lost during surgery and immediately return it to you.
Can Blood Donated by Family and Friends Be Used for My Transfusion?Family or friends, who may have the same blood type as you can provide a directed blood donation. However, most studies show that directed donations are no safer than blood donated by healthy community volunteers. In fact, blood donations from close relatives are more likely to cause a serious immune reaction. In these situations, doctors must treat the blood with radiation before it can be used safely.
How Is the Risk of Using Blood From a Volunteer Allogeneic Donor Decreased?The safety of volunteer donor blood results from actions taken at several levels.
By the Donor
- Self exclusion from the donor process for confidential reasons
At the Blood Center (Collection Facility)
- Thorough donor interviews
- Careful testing of blood for transfusion transmissible disease
At the Hospital
- Monitored and careful blood storage procedures
- Precise compatibility testing
- Through knowing your options
- Understanding the transfusion process, the benefits, risks and alternatives prior to consenting to a transfusion. These alternatives include the use of drugs to assist your bone marrow to replace blood, use of autologous (pre and perioperative) donations and removing contaminating white cells.
Does It Cost More to Have Blood Filtered to Remove White Cells?Typically filtration adds 10% to 20% to the cost of preparing blood. The significant cost savings in hospital charges and reduced patient hospital stay associated with the use of filtered, leukocyte reduced blood and platelet transfusions offsets the cost of leukocyte reduction by filtration. It has been estimated that for surgery patients alone the use of filtered blood would save the U.S. health care system $6-12 billion dollars per year. Figure 1 Pall Filtered Blood Decreases Complication in Surgery Patients
Figure 2 Pall Filtered Blood Improves Surgical Patient Outcomes and Reduces Patient Charges
Your Blood Transfusion Options
- Avoiding transfusion by drug-assisted blood production by your bone marrow
- Donating blood for your own use
- Using blood donated by family and friends that is your blood type and may require irradiation
- Using filtered, leukocyte reduced blood from volunteer donors
Cut out the card below and fold it in half. Sign the card and keep it in your wallet.
If you need a transfusion, give it to your physician.
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