Patient Information

Patient Information about Blood Transfusions

As part of your care at Legacy Health, it may be necessary to administer blood or blood components. Since certain risks are associated with blood transfusion, we take great efforts to ensure that transfusion is as safe as possible. Please take a few minutes to read about the risks and alternatives to blood transfusion.

Our Screening Process 

Your doctor will use blood transfusion only when, in his/her judgment, it is medically necessary and in your best interest.

The majority of blood used at Legacy Health System is supplied by our local blood centers and is obtained from carefully screened, healthy donors.  The screening process includes thorough questioning about past and present health status, lifestyle and travel history, which eliminates donors who may have transmissible diseases.

All blood sent to Legacy is tested for evidence of infection. While this testing has greatly improved safety, the systems are not perfect and there is still a small chance of getting an infection through transfusion.

Before transfusion, we test your own blood to identify blood group, Rh type and the presence of any unusual antibodies. Your blood is crossmatched against the blood you are to receive to ensure compatibility.

Identification errors are the cause of most serious complications of blood transfusion. Strict adherence to hospital procedures for patient identification minimizes the risk of misidentification. The hospital wristband is crucial to insuring that you receive the correct blood. It is hospital policy that both the person drawing your blood and the transfusionist check the identification band. The blood bank will ask for a new sample if the original specimen identification is incomplete, unclear or questionable. We do this for your protection.

Autologous Blood Donation

You and your doctor may decide to have some of your own blood withdrawn in advance of elective surgery. Receipt of your own blood guarantees compatibility and freedom from all risks of infection from other individuals. We do this procedure, known as autologous donation, one to five weeks before your surgery. In some cases, we can collect autologous blood at the beginning of surgery. Blood shed during or after an operation may be collected, washed and re-infused. Autologous donation sites are located at local blood centers. Autologous donation does not guarantee that you will not need to receive additional blood from voluntary donors and is subject to risk of clerical error and bacterial contamination.

Designated Blood Donation

Legacy Health System discourages the use of designated blood donors (relatives, friends, etc.). We believe that screening and testing of volunteer donors produces a product as safe as or safer than blood from any designated donor. However, there are some potential problems with designated donations, which you should be aware of before electing to use this option:

  • Designated donors may not have blood that is suitable for you, or the blood may have abnormal infectious disease markers that will not allow its use.
  • Designated blood donors do not always make a voluntary decision to donate blood, but instead, feel pressure to donate blood by friends or relatives. Without such pressure, donors might regard themselves as unsuitable or questionably suitable for blood donation.
  • Blood from a near relative must be treated with x-rays to prevent a rare transfusion reaction that occurs with related donors. This treatment may delay the availability of donated products.
  • Testing and preparation take about five days.
  • There will be an increased cost for these products.

Bloodless Surgery

We have a bloodless surgery program for those who for religious or other reasons feel strongly that they do not want a transfusion. A consultation can be arranged to explore this option more fully.

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Some Potential Risks of Blood Transfusion

HIV Infection

All donated blood is tested for evidence of HIV and this significantly reduces the risk of acquiring AIDS through transfusion. While there is no cure for AIDS, medications helpful in treatment are available.

Hepatitis

Transfusion now rarely causes hepatitis infection. Of the people who acquire hepatitis C, 85 percent develop chronic infections, 20 percent develop cirrhosis and 1.5 percent develop liver cancer. The combined mortality from cirrhosis and hepatocellular carcinoma is 14.5 percent over a period of 20-30 years. Helpful treatments for chronic Hepatitis C are now available.

Other Viruses

Other viruses not listed here can occasionally cause serious problems in some recipients.

Antibody Development and Immune Reaction

Some patients develop antibodies when exposed to another person’s blood; this can cause problems during a subsequent transfusion. The most common immune reactions are mild and consist of allergies or fever.  More serious immune reactions can result in immediate breakdown of transfused red cells, leading to clotting abnormalities, kidney problems, shock and sometimes death. Misidentification is the cause of many of these reactions.  A less serious immune reaction can occur with breakdown of transfused red cells several days after transfusion.  Antibodies in your blood not detected during compatibility testing cause these delayed hemolytic reactions.  They accounted for 10 percent of all deaths due to red-cell transfusion over a 10-year period.

Contamination by Bacteria

Blood from donors is usually sterile, but bacteria occasionally gets into the blood unit and can multiply during storage. The severity of reaction to transfusion is variable. Some patients have fever and chills, while others develop serious infections requiring antibiotics.

Transfusion-Related Acute Lung Injury

This occurs within four hours after transfusion and causes shortness of breath and fluid accumulation in the lungs.  Less serious lung problems can also occur in patients with heart failure.

Transfusion-Mediated Immunomodulation

Data suggests that transfusion may cause a temporary reduction in your natural immunity. This may lead to more postoperative infections and may hamper your ability to fight cancer. Immunomodulation is not a problem with autologous donations.  Reduction of the white cells used in the majority of units transfused at Legacy appears to eliminate this problem.

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Estimated Risks of Blood Transfusion

Estimates for some of the risks of transfusion are listed below. Estimated frequency indicates how often a single unit might have the condition (for example, 1 in 1,000,000 units of blood can have the Hepatitis A virus).  Risks may decrease further with advances in testing.

 Risk Factor  Estimated Frequency   Deaths per Million Transfusions 
 Infection
 Viral 
 Hepatitis A  1/1,000,000 
 Hepatitis B  1/205,000-1/488,000 
Hepatitis C   1/1,935,000*  NA 
HIV (AIDS)   1/2,135,000*  NA 
 Bacterial Contamination
Red Cells 1/500,000  0.1-0.25 
Platelets  1/12,000  21 
 Acute Hemolytic Reactions  1/250,000-1/1,000,000 0.67 
 Delayed Hemolytic Reactions  1/1,000 0.4 
Transfusion Related Lung Injury   1/5,000 0.2 

From Goodnough, et al NEJM 340 6: 438-447, 1999

*From Dodd, et al Transfusion 42: 975-979

NA = Not available


Possible Side Effects of Blood Transfusion

Reaction type  Signs & Symptoms  What to do 
 Mild allergic Rash, itching, hives or chills*  Call physician 
 Severe allergic Flushing, wheezing, dizziness, restlessness, or uneasy feeling*  Call physician immediately, go to Emergency Room or call 911 
 Fever  Chills or unexpected fever over 100 degrees* Call physician 
 Hemolytic (destruction of red blood cells) Fever with chills, back pain, difficulty breathing, dizziness, unexplained bleeding, no urination or blood in urine  Call physician immediately, go to Emergency Room or call 911 
 Hepatitis Onset in weeks to months, fever, dark urine, yellow skin, loss of appetite, feeling run down, nausea, joint pain, enlarged liver, etc.   Call physician 

* Reactions occur immediately or within a few hours.
Most reactions to blood transfusions are minor and the benefits most often outweigh the risks.

 

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