1. Blood Transfusion
Introduction
Abloodtransfusion is thetransfer ofbloodorbloodproductsfromone person(donor)into
another person'sbloodstream(recipient). This is usually doneas alife saving maneuver to
replace bloodcells or bloodproductslostthroughsevere bleeding,duringsurgery whenblood
loss occurs ortoincrease thebloodcountinan anemic patient.Thefollowing material is
providedtoall patients and/ortheir family members regarding bloodtransfusions andthe use
ofbloodproducts.Althoughinmostsituations thelikelihood ofa bloodtransfusion associated
withsurgery is uncommon,attimes patientsmay require bloodproducts.Youareencouraged
todiscuss yourparticular riskof transfusion withyourdoctor.
Youroptionsmay belimited bytime andhealth factors,soit is importanttobegincarrying out
yourdecision as soonas possible. Forexample, if friends orfamily members are donatingblood
fora patient(directed donors),theirbloodshouldbedrawnat least twoworkingdaysprior to
theanticipated need toallow adequatetime fortesting andlabeling. Youare also encouraged
tocheck withyourinsurance companyfor theirreimbursement policy.
Thesafest bloodproductis yourown,soif atransfusion is likely, this isyour lowestrisk choice.
Unfortunatelythis optionis usually onlypractical whenpreparingfor elective surgery.Inmost
otherinstances thepatientcan notdonatetheir ownbloodduetotheacute nature oftheneed
forblood.Althoughyouhavethe righttorefuse a bloodtransfusion,this decision mayhold
life-threatening consequences. Ifyouare a parent decidingfor yourchild,youas theparent or
guardian mustunderstandthatin a life-threatening situation yourdoctorswill actin your
child's bestinterest toinsure yourchild's health andwell beingin accordance withstandards of
medical care regardless ofreligious beliefs. Please carefully review this material anddecide with
yourdoctorwhichoption(s)youprefer.
2. Toassure asafe transfusion make sure yourhealthcare providerwhostarts thetransfusion
verifies yourname and matches ittothebloodthatis goingtobetransfused.
Ifduring thetransfusion youhave symptomsof shortnessof breath,itching, fever orchills or
justnotfeeling well,alert the persontransfusing thebloodimmediately.
Bloodcan beprovided fromtwosources: autologousblood (usingyourownblood)ordonor
blood (usingsomeoneelse'sblood
AutologousBlood(usingyourownblood)
Pre-operative donation-donatingyourownbloodbeforesurgery.Thebloodbankdrawsyour
bloodandstores ituntil youneedit duringorafter surgery. Thisoptionis only fornon-
emergency (elective) surgery.Ithas theadvantage ofeliminating or minimizing the needfor
someone else's bloodduringandafter surgery. Thedisadvantage is thatitrequires advanced
planning whichmay delay surgery.Somemedical conditions mayprevent thepre-operative
donationofbloodproducts.
Intra-operativeautologoustransfusion -recyclingyourbloodduringsurgery.Bloodlostduring
surgery is filtered,and putbackintoyourbodyduringsurgery.This can bedonein emergency
andelective surgeries. Ithas theadvantage ofeliminating or minimizing the needfor someone
else's bloodduring surgery. Largeamounts ofbloodcanbe recycled. Thisprocess cannotbe
usedif cancer or infection is present.
Post-operativeautologoustransfusion -recyclingyourbloodaftersurgery. Bloodlost after
surgery is collected,filtered and returnedtoyourbody.Thiscan bedonein emergency and
elective surgeries. Ithas theadvantage ofeliminating orminimizing theneed forsomeone else's
bloodduringsurgery.This process can'tbeused inpatients where cancer orinfection is
present.
3. Hemodilution-donatingyourownbloodduringsurgery.Immediatelybefore surgery,some of
yourbloodis takenandreplaced withIVfluids.After surgery,yourbloodis filtered and
returned toyou.Thisis doneonlyfor elective surgeries. This processdilutes yourownbloodso
youlose less concentrated bloodduringsurgery.Ithas theadvantage ofeliminating or
minimizing theneed forsomeone else's bloodduringsurgery. Thedisadvantage ofthis process
is thatonlya limited amount ofbloodcanbe removed,andcertain medical conditions may
preventhemodilution.
Apheresis-donatingyouownplateletsandplasma.Before surgery, yourplatelets andplasma,
whichhelp stopbleeding,are withdrawn,filtered andreturnedtoyou whenyouneed itlater.
This canbe doneonlyfor elective surgeries. Thisprocess may eliminate theneed fordonor
platelets andplasma, especially in highblood-lossprocedures. Thedisadvantage ofthis process
is thatsome medical conditions may preventapheresis, and inactual practice ithas limited
applications.
DonorBlood(Usingsomeoneelse'sblood)
All donorbloodistestedfor safety makingits risks very small, butnoscreening program is
perfect andrisks, suchas contractionof thehepatitis virus orotherinfectious disease still exist.
Volunteerblood -bloodcollectedfromthecommunitybloodsupply(bloodbanks).Thishas
theadvantage ofbeing readily available, andcan belife-saving whenyour ownbloodisnot
available. Thedisadvantage is thatthere isa risk ofdisease transmission, suchas hepatitis or
AIDS,andallergic reactions.
Designateddonorblood -bloodiscollectedfromthedonorsyou select.You canselect people
withyourownbloodtypewhoyoufeel are safe donors.Like volunteer blood,thereisstill arisk
ofdisease transmission, such ashepatitis and AIDS,andallergic reactions. This process usually
4. requires several daysfor advanced donation.Itmaynotnecessarily besafer thanvolunteer
donorblood.
Whatisit?
Bloodtransfusion is the processof transferring bloodora blood componentfromone person,
thedonor,toanotherperson,the recipient.
Whoneedsthisprocedure?
Bloodtransfusions are giventoincrease the blood'sabilitytocarry oxygen, torestore the
body'sbloodvolumewhenthere has beena greatbloodloss,toimprove the blood'sclotting
ability, andtoimprove a recipient's immunity toinfection. Dependingupontherecipient's
needs,a doctormay ordera wholebloodtransfusion, orabloodcomponent.Blood
componentsinclude red bloodcells,white bloodcells, platelets,immunoglobulins, or fresh
frozenplasma, which is theliquidpart oftheblood.Wholebloodisusually usedwithpatients
whohave losta lotofblood,andtomake sure thebody'stissuesare receiving enoughoxygen.
Red bloodcells restore theblood'sability tocarry oxygen,suchas inpatients whoare bleeding
orhave anemia. Whitebloodcells are given topatients withlife-threatening infections that
reduce thewhitebloodcell count.Platelets are often giventopatients withbloodclotting
disorders,such as hemophilia orvon Willebrand's disease. Plasma also helps withblood
clotting,andis oftentransfused in patientswith liver failure. Immunoglobulins are thedisease
fightingcomponents ofbloodandare also given tobuildupimmunity, especially inpatients
whohave beenexposedtoan infectious disease orwhoseantibodylevels are low,suchas those
withAIDS.
HowdoIprepareforthisprocedure?
Ifyou knowyouwill beundergoingsurgery,youmay wanttodonate yourownbloodamonth
before yoursurgery.This is called an autologoustransfusion,and thebloodyoudonateis
5. storedat thehospitalfor youruse only.Ifyou needa transfusion during orafter surgery, your
ownbloodwill beused.Or,youcouldask afriend orfamily member withthesame bloodtype
todonatebloodspecifically for you.Thisis called a direct donation.Manypeople feel more
comfortable knowingthesource ofthebloodfora transfusion. However,the medical
community has adoptedstringentscreening methodstoensure bloodtransfusions are
extremely safe. Blood donorsmustanswer questions abouttheirgeneral health,lifestyle, and
any medical conditions thatmightdisqualify them asdonors.All donatedbloodiscarefully
checkedfor viral hepatitis, AIDS,syphilis,andother viruses. Nobloodis useduntil all test
results have shownthatitis safe. Ifyou havehad allergic reactions toprevioustransfusions,
youshouldmake sure yourdoctoris aware ofthis. Treatments are available sotransfusions can
begiven topeoplewhohave hadallergic reactions.
Howisthisprocedureperformed?
All donatedbloodisclassified bytype,either A,B,AB, orO,andas RH-positive or RH-negative.
Toprotecttherecipient, the bloodismatched tohisor herbloodtype.Before starting the
transfusion, thehealthcare professional cross-matches thedonorbloodbymixinga dropofit
withtherecipient's tomake surethey are compatible.The healthcare professional will also
double-checkthatthe bloodisintended fortherecipient. Then,the donorbloodisgiven
slowly,throughanintravenous (IV)linedirectly into theveins. Bloodtransfusions are given in
units,withone standardunit ofbloodequalingaboutone pint.Duringthetransfusion, medical
personnel watchthepatient closely forany adverse reactions. When thetransfusion is
complete, acompress bandageis placed over thearea where theneedle hadbeen inserted.
People withheartdisease are given transfusions even more slowlytoavoid overloading the
bodywithfluid.Peoplewith serious diseases thathaven't respondedtoothertreatments might
benefit froma transfusion methodcalled hemapheresis. Hemapheresis is aprocess that purifies
thebloodbyremoving bloodfromthepatient, cleaning theharmful components fromit,then
6. returning thepurified bloodtothepatient.Cytapheresis is a typeofhemapheresis thatremoves
excess amounts ofcertain bloodcells. Itmight beusedto treat conditionssuch as
polycythemia, leukemia, andthrombocytosis.Anothertypeof hemapheresis called
plasmapheresis removes harmful substancesfrom theplasma. This treatment mightbeused for
patients withGuillain-Barre syndrome andmyasthenia gravis.
WhatcanI expectaftertheprocedure?
Aftera bloodtransfusion,you will becarefully monitoredforany adverse reactions. Anallergic
reaction is indicated byswelling, rash,itchiness, dizziness, fever, andheadache. Whenbloodis
mismatched, therecipient's bloodreactstothe transfusedred bloodcells anddestroysthem.
This is called ahomolytic reaction. Symptomsmay include general anxiety ordiscomfort, then
breathingdifficulty, flushing,a feeling of pressure inthe chest,andsevere backpain.Itis rare
forthese typesof reactions tobelife threatening.
Definition
Ahemolytic transfusion reaction isa serious problem thatoccursafter a patientreceives a
transfusion ofblood.Thered bloodcells thatweregiven tothepatient are destroyedbythe
patient'sownimmune system.
Alternative Names
Bloodtransfusion reaction
Causes, incidence, andrisk factors
Bloodis classified into different blood typescalled A,B,AB,and O.
7. Theimmune system normally can tell itsownbloodcells from bloodcells from anotherperson.
Ifother bloodcells enter yourbody,yourimmune system maymake antibodies again them.
These antibodies will worktodestroythebloodcells thatthebodydoesnotrecognize. For
example, a personwithtypeAbloodmakes antibodies against typeB bloodcells.
Anotherway bloodcells maybe classified is by Rhfactors. Peoplewhohave Rhfactors in their
bloodare called "Rhpositive." Peoplewithoutthesefactors are called "Rh negative."Rh
negative peopleform antibodies against Rhfactor if theyreceive Rhpositive blood.
There are also otherfactors toidentify bloodcells,in additiontoABO andRh.
Bloodthatyou receive in a transfusion mustbe compatible.Being compatible means thatyour
bodywill notformantibodies against thebloodyoureceive. Blood transfusion between
compatible groups(suchas O+toO+)usuallycauses noproblem.Blood transfusion between
incompatible groups(suchas A+toO-)causes animmune response.This can leadtoa very
serious transfusion reaction. The immune system attacksthe donatedblood cells,causing them
toburst.
Today,all bloodiscarefully screened. Modern labmethodsand manychecks have helpedmake
these transfusion reactions very rare.
Symptoms
Bloodyurine
Chills
Fainting ordizziness
Fever
Flank painor backpain
8. Rash
Symptomsoftransfusion reaction usually appearduringor rightafter thetransfusion.
Sometimes, theymay developafter several days(delayed reaction).
Medicalhistoryinterview —Allblooddonorsareaskedquestions abouttheirmedical history
tohelpdetermine ifthey cansafely donatebloodwithoutexperiencing anynegative health
effects [1].Duringthedonation,one unitofblood(approximately 500mL or17fluid ounces) is
removed.
Heart andlung disease — Potentialdonors are
askedif theyhave ever hadheart, lung,orblooddiseases.
Ingeneral, people withheart disease, heartvalve
conditions,irregular heartbeat,disease oftheblood
vessels inthe brain,heart failure, andcertain lung
conditions are notallowedtodonate bloodunlessthis has
beencleared withtheir healthcare provider.
Othermedical conditions - Potentialdonorsare asked if theyfeel healthy andwell on
theday ofdonation.
Seizures — Peoplewitha historyof seizures can
donateblood,providedtheyhave hadnoseizures within a
certain period oftime (usually 1to6 months).
Recent surgery — Peoplewhohave undergone
recent surgery are permittedtodonatebloodwhen
healing is complete andtheyhave resumed full activity.
However, ifa transfusion was givenat thetime ofsurgery,
donationis notallowed forone year.
9. Pregnancy —Women whoare pregnantare not
permittedtodonate bloodduringpregnancyandfor six
weeks afterthe pregnancyends.
Agerequirement —The minimum agefor blood
donationis 16or 17years, dependinguponthestate.
Whenallowed, 16year oldsmust bringa signed
permission formfrom aparent. Inmostcases, there is no
upperage limit fordonation, althoughapproval from the
donor'sphysician is required insome cases.
Weightrequirement —Individuals weighing less
than50 kg(110pounds)areusually notpermitted to
donateblood.Theless a donorweighs,thegreater the
likelihood ofhaving areaction, such as dizzinessand
fainting following donation.Althoughreactionstoblood
donationare rare, individuals weighing between50 and54
kg(110and119 pounds)aremost likely toexperience
reactions.
Medicalevaluation—Inadditiontoamedical history, donorsundergoabrief physical
examination beforedonation tocheckforany obvioussigns ofillness orconditions thatwould
disqualify themfrom blooddonation.
Vital signs— The pulse,bloodpressure,and
temperature ofa donorare checkedbefore donation.
Individuals witha fever, highbloodpressure,very highor
very lowheart rate(withthe exceptionof highly
conditionedathletes and thoseonbetablocker
10. medication), oran irregular heart beatare temporarily not
permittedtodonate blood.
Bloodtest —A small bloodsample is takenfrom a
fingerstick andtested tocheckfor thenumberof redcells
orthe amountofhemoglobin inthe blood.Thisis doneto
ensure thatthedonoris notanemic orlikely tobecome
anemic oriron deficient after theydonate.Individuals
withhemoglobin levels thatare tooloware temporarily
notpermittedtodonate blood.(See"Patientinformation:
Irondeficiency anemia".)
Timeintervaluntilnextdonation—Donorsareeligible todonateno soonerthan 56daysafter
their previous donation.However,thisminimum interval canvary, dependinguponhow
rapidly theperson'sbodyis abletoreplenish theirred bloodcells. Somedonors,especially
women whohaveheavy menstrual periods, will notbeabletodonate every 56daysbecause
their ironstores are notsufficient toreplenish thelostred bloodcells.
APHERESISDONATION
Atechnologycalled apheresis has made itpossible tocollect specific components ofblood
duringthedonation procedure.Apheresis is usedtoselectively collect red bloodcells,platelets
(bloodcomponentsthatplayan importantrole in clotting),plasma, andgranulocytes (atypeof
infection-fighting white bloodcell).
Red bloodcells — Donorscangive red bloodcells
byapheresis once every 16weeks. Thisis less frequently
thanwhole blooddonationbecausea greater amount of
redbloodcells are collected during theapheresis
procedure.
11. Platelets — Donorscan give platelets upto24times
peryear. About1percent ofpeoplehave a mildreaction to
oneof thesubstances (citrate)thatis mixed withthe blood
duringplatelet donation;thereaction can include feelings
ofnumbness andtingling, muscle cramping, andnausea.
Thereaction canbe treatedorprevented bytakinga
calcium supplementbefore orduringthe donation.
Granulocytes — Donorsofgranulocytes may be
given granulocyte colonystimulating factor (G-CSF)
and/ora glucocorticoid medication called
dexamethasone onthe daybefore donationtoincrease the
number ofgranulocytes intheir blood.Glucocorticoids
are usually notgiven toindividuals whohave diabetes,
gastrointestinal ulcers, or glaucoma. Theside effects ofG-
CSF and dexamethasone may include headache, jointpain,
fatigue,insomnia, allergic reactions, andfever.
SCREENINGMEASURESTO PROTECTTHERECIPIENT
Screening ofblooddonorshelpstoensure thatthedonatedbloodissafe for transfusion intoa
recipient. Avariety of different measures are used forthis screening.
Elimination ofpayment fordonation — Since the
late 1970s,volunteer donorshave beenthe sourceof all
wholebloodandbloodcomponentsin theUnitedStates.
Donorsare sometimes paidfor donatingplasma thatis
usedtomanufacture otherbloodproducts.However,to
protecttherecipient, these productsundergoadditional
purifying tests.
12. Screeningforinfections
Humanimmunodeficiencyvirus(HIV) —Thehumanimmunodeficiency virus (HIV)is thevirus
thatcauses AIDS.Avariety of measures are used toscreen donorsforpotential oractual HIV
infection, including questioningthedonoraboutany signsor symptomsof HIVandbehaviors
thatincrease therisk ofHIV.
People whowanttobetestedforHIV orothersexually transmittedinfections shouldNOT
donatebloodforthis purpose.Eventhoughdonatedbloodistestedfor HIV,thetestsare not
perfect;a personwhomight have beenexposedtoHIVcould transmit thevirus toarecipient if
theydonateblood.Free andanonymous HIVtestingis available elsewhere (see
www.hivtest.org).
Hepatitis—Hepatitisisaninfection thatcauses inflammation oftheliver. Blood donorsare
routinely screened todetermine if theyhave or havebeen exposedtohepatitis.
People whohavehadviral hepatitis (A,B,orC) or
hepatitis ofunknownorigin after their11thbirthdayare
permanently disqualified fromdonatingblood.
People whohaveever hada positive testfor
hepatitis B surface antigen (amarker for hepatitis B)are
permanently disqualified fromdonatingblood.
People whohavehadsexual contactorhave lived
in thesame dwelling (eg,house,dormitory)withsomeone
whohas hepatitis(A,B, orC) are disqualified for12
monthsafter their last exposuretothatperson,depending
upontheparticulars oftheexposure.
People whohavereceived abloodtransfusion are
notpermittedtodonate bloodfor12monthsafter the
dateof transfusion.
13. Inmany states, peoplewhohave received a tattoo
ora bodypiercing are notpermittedtodonatebloodfor
12months.In some states,where theseindustries are
carefully regulatedbystate law toensure thatthe
procedures are sterile, earlier donationmay bepermitted
withouttheneed forany waitingperiod.
Parasiticdiseases—Blooddonorsareroutinelyasked questionsaboutpossible exposure to
several parasitic diseases thatcan betransmitted by bloodtransfusion.
Malaria — Transfusion transmitted malaria is
common insome parts oftheworld,butisextremely rare
in theUnitedStates.Donorswhohave hadmalaria are not
permittedtodonate forthree years after theybecome free
ofsymptoms.Travelers toregions where malaria occurs
are notpermittedtodonate bloodforoneyear after they
leave the area, providedtheyhave nothadsymptomsof
malaria. Immigrants from orresidents of countries where
malaria is common are notpermittedtodonatefor three
years after their departurefrom thatcountry.(Residency
is usually defined asliving inthecountry foratleast five
years.)
Chagas' disease andbabesiosis — Transmission of
Chagas' disease (American trypanosomiasis) by
transfusion is rare in theUnitedStates.Blooddonors are
askedif theyhave ever hadChagas' disease andmost
donatedbloodistested forChagas' disease.
14. Transmission ofbabesiosis (a malaria-like illness spreadbyticks) bytransfusion isuncommon.
Blooddonors are askedif theyhave ever hadthisdisease.
Creutzfeldt-Jakobdisease (CJD)andvariant CJD —
Creutzfeldt-Jakobdisease (CJD)is arare butfatal
neurologic disease. Variant Creutzfeldt-Jakobdisease
(vCJD)is a somewhatsimilar disease thatfirst appearedin
theUnitedKingdom (UK)in1996.Affected individuals
may have nosymptomsof CJDorvCJD formany years.
Todate,there have beennoreported cases oftransfusion-related transmission ofCJD andonly
fourreports ofprobabletransmission ofvCJD inthe UK.Despite this extremely small (vCJD)
risk,donorswhomeet one ormore ofthefollowing criteria are notallowed todonate:
Have spent≥3 cumulative monthsinthe UKfrom
1980to1996,or
Have spent≥5 cumulative years inEurope from
1980topresent, or
Ascurrent orformer USmilitary personnel,
civilian military employees andtheir dependents,have
lived for≥6 monthsat USmilitary bases in Northern
Europefrom 1980to1990 orelsewhere inEurope from
1980to1996,or
Received abloodtransfusion in theUKor France
between1980 topresent,or
Injected bovine(from cows)insulin from theUKor
othercountries witha historyof madcowdisease (bovine
spongiformencephalopathy)
15. Bacterialinfection—Bacteriacan getintodonatedbloodif adonorhas a bacterial infection, if
bacteria onthe skingets intothebloodfromthe needle stick,orif there is askin infection near
thelocation where thebloodis drawn.Toreducethe likelihood ofbacterial contamination of
blood,theskinaroundthe site iscarefully examined and cleaned before theneedle is inserted.
Donorswhohave a fever,whodonotfeel well, orwhoare takingoral antibiotics (except for
acne) are notpermittedtodonate blood.Theserestrictions also applytoindividuals whoare
bankingbloodfortheir ownuse (see'Autologousblooddonation' below).
Othermedicalconditions—Inordertoprotecttherecipientagainst non-infectious
complications, thedonoris evaluated for certain medical conditionsbefore blooddonation.
Cancer —There have been noreportedcases of the
transmission ofcancer bybloodtransfusion. However,
because suchtransmission is theoretically possible,
donorsare screened for ahistory ofcancer.
Donorswhohave hadcancer of asolid organor tissue (suchas thelung,liver, breast)are
permittedtodonate ifthey havebeen symptom-free and cancer-free fora defined periodof
time, usually twotofive years.
Donorswhohave hadbloodcancers (suchas leukemia orlymphoma) are permanently
disqualified from donating.
Donorswhohave hada superficial cancer thathas beencompletely removed bysurgery (such
as basal cell cancer of theskinor early cervical cancer) can donatebloodwithoutanywaiting
period.
Hemochromatosis —Individuals withhereditary
hemochromatosis (a conditionin whichfrequent removal
ofbloodis thestandardtreatment) can donatetheir blood
16. fortransfusion if theymeet other criteria for beinga
donorandif thebloodbankhasmet certain regulations
from theFoodandDrugAdministration (FDA).There is
norisk oftransmitting this conditiontotherecipient. (See
"Patientinformation: Hemochromatosis (hereditary iron
overload)".)
Medications—Mostmedicationstakenbydonorsdonotposea risk torecipients. However,
five drugsare knowntocause birthdefects andare considered duringdonorscreening:
Etretinate (Tegison®),usedfor severe psoriasis
Acitretin (Soriatane®),also usedfor severe
psoriasis
Isotretinoin (Accutane®),usedforsevere acne
Finasteride (Propecia®,Proscar®)usedfor benign
prostatic hypertrophyandhairloss.
Dutasteride (Avodart®)usuallygiven forprostatic
enlargement
Donorswhohave takenisotretinoin andfinasteride are asked towait onemonthafter thelast
dosebefore donatingblood,donorswhohavetakendutasteride are asked towaitsix months,
anddonorswhohave takenacitretin are askedtowait three years.Individuals whohavetaken
etretinate are permanently disqualified fromdonatingblood.
People whotookaspirinor aspirin-containing medications within theprevious 48hours are
allowed todonatewholebloodbutare notallowedtodonate platelets byapheresis. People
whotookwarfarin (Coumadin®)are generally notallowed todonatebloodforapproximately
7days after thelast dose.Thereason for thisis thatthisblooddoesnotcontain sufficient
quantities ofclottingfactor.
17. Laboratorytestingofdonatedblood —Afteraunitofbloodhasbeendonated,thebloodis
testedin a laboratoryfor infectious diseases thatcan betransmitted bybloodtransfusion.
These include testsfor HIV,hepatitisB, hepatitis C,human T-lymphotropicvirus (HTLV),
WestNile virus,syphilis, andin most areas, Chagas' disease. (See "Patient information: West
Nile virus infection".)
Confidentialunitexclusion(CUE)—Theconfidentialunit exclusion (CUE)process allows
someone whohas donatedbloodtoconfidentially indicate thathis orher bloodshouldnotbe
given toothers.This processprotectsindividuals whofeel pressured todonateatthe
workplace orduringcommunity blooddrives.Donors are askedtoplace a barcodesticker on
their donationform,indicating if their bloodshouldbeused.This isdone afterthe interview,
butbeforedonation.This procedureis used bysome,butnotall,USbloodbanks.
Registryofdeferreddonors—Aregistryofdeferreddonorscontains names of individuals who
have beendisqualified fromblooddonationin thepast.Somedonorsin theregistry have
infectious diseases suchas hepatitis B orHIVinfection. Theoretically, itis possible thatan
individual withone ofthese diseases couldhave apositive testresult at onetime butnegative
testresults at alater time.
Otherdonorsin theregistry have providedinformation in thepastthatdisqualified them from
blooddonation.Adonor'sname is usually checkedagainst this registry beforeandafter
donation.Thereason for thedeferral is notusually available tostaff atthe collection facility.
Telephonecallbacks—Afterdonatingblood,donorsaregivena phonenumberso thattheycan
call the donationcenter toreportanyfactors thatmay affect theuse oftheir bloodortoreport
symptomsof infections in thefirst daysafter donating(suchas symptoms ofupperrespiratory
tractinfection orgastrointestinal illness). Suchreportswill beevaluated and theunitof blood
may bedestroyed.
RISKOFINFECTIONFROMATRANSFUSION
18. Safetymeasures, suchas improved screening tests,have dramatically reducedthe riskof
acquiring a viral infection from abloodtransfusion. Recent estimates suggestthefollowing
risks ofdeveloping certain infections after receiving a unitofblood:
Onein 58,000to269,000forhepatitis B
Onein 2million forhepatitis C
Onein 2million forhuman immunodeficiency
virus (HIV)
Onein 2million forhuman T-cell
lymphoma/leukemia virus (HTLV)
AUTOLOGOUSBLOODDONATION
Autologousblooddonationiswhen adonordonates bloodforthemselves several daystosix
weeks aheadof ascheduled surgery,whenbloodmightbe needed.Autologousblooddonation
reduces therisk ofmost,butnotall, infectious complications of bloodtransfusion.
POTENTIALCOMPLICATIONSOFBLOODDONATION
Mostpeople whodonateblooddonothaveany complications thatrequire medical care. The
mostcommon complications include bruisingor soreness atthe needle siteand fatigue.
Asmall percentage (2to5percent) ofpeoplefeel faint and/orpass outbefore,during,orafter
donatingblood.Thisis more common thefirst time aperson donatesandin peoplewhoare
younger.Drinking a16ounce (473mL)bottleof waterbefore donatingmay reducethis risk.
PreparationforBloodTransfusion
1. Before a bloodtransfusion is performed,thedoctorwill ordera bloodspecimen toconfirm
thepatient's bloodtypeandcompatibility withthebloodbeingdonated.Thistest is done
even whenthepatient is donatinghisownblood.This isdone toensure thepatient'ssafety
andhealth.
19. TransfusionProcedure
2. Before the transfusion begins,thepatient mustsign aconsent form.The doctorwillthen
orderthe patienttotake medications, suchas antihistamines andacetaminophen, before
thetransfusion. Before the transfusion begins,twonurses will checkthepatient's identity.
Thenurse performing thetransfusion will then insert anintravenous line intothepatient's
arm.
Nurse'sResponsibilityDuringProcedure
3. Thenurse handling thetransfusion has anumber ofresponsibilities toensure thatthe
procedureis performed correctly andtoensure the patient'ssafety andhealth. Before,
duringand afterthe transfusion,the nursewill check thepatient's temperature,pulse and
blood pressure ,and will checkfor anysigns ofadverse reactions tothetransfusion. While
reactions are rare, theyare monitored. Symptomsforadverse reactions include breathing
problems,chills, fever, itching/hives, rash,nausea, lower backpain, apprehensive feelings,
tingling ornumbness,heat, pain,orswelling at thesite where theIVis inserted.Patients are
urgedtokeepthe nurse abreastof anysymptoms theyexperience.
WhatPatientCanExpectDuringTransfusion
4. Blood transfusions are relatively simple procedures thatcanupto1-1/2 totwohours,
dependingontheamount ofunits beingtransfused intothepatient. Generally, most
transfusions require at least twotothreeunits.The patientis allowed toeat anddrink
duringtheprocedure andis able touse thebathroomwithassistance fromthe nurse.
WhatAretheRisksAssociatedwithBloodTransfusions?
TheFoodand DrugAdministration (FDA),TheAmerican Association ofBlood Banks (AABB),
andThe JointCommission onAccreditation of Healthcare Organizations (JCAHO)regulate
20. theprocess ofobtaining,storing,preparing, andtestingof blood.Theseorganizations are
responsible forensuring a safe bloodsupply.
Blooddonors mustgothroughanextensive screening process beforethey are abletodonate
blood.Afterbloodisdrawn,it is testedforbloodtype,RHfactor, as wellas for antibodies.
Multiple individual screening testsare performed forevidence ofinfection and viruses. With
thisextensive testing,thechance of receiving a unitof bloodcontainingtheHuman
Immunodeficiency Virus (HIV)orhepatitisC virus is around1 in2 million, andless than1in
200,000forhepatitis B.1
HowDoIPrepareforaBloodTransfusion?
Youcan expectthatyour doctorwill ordera bloodspecimen toconfirm your
bloodtypeandtocheckcompatibility withthedonorunit.Compatibility
testing(also referred toas cross matching )is doneeven if youhave donatedyour
own(autologous)blood.
Check withyourdoctorabouthowmuchtime toplan foryour blood
transfusion procedure.Each unitof bloodusuallytransfuses over1½ to2hours.
Sometransfusions are for2-3 units.Youmay behere forseveral hours depending
onwhatyour doctorhasorderedfor you.Please arrange yourtransportation
accordingly.
Where DoIGoformyBloodTransfusion?
If YouAreaPatientintheHospital:Yournurseadministers yourblood
transfusion atyour bedsideandmonitors youthroughouttheentire procedure.
21. If YouAreaPatientComingfromHometothePacificCampus: Blood
transfusions are given in ourAmbulatoryCare Unit(ACU),2351Clay Street,on
the6thfloor.Register withtheadmitting staff intheAmbulatory Care Unit
whenyouarrive. Parkingis available in thegarage locatedat 2405Clay Street
(corner ofClay and WebsterStreets).
If YouAreaPatientComingfromHometotheDaviesCampus: Thestaffwill
contactyouthe daybefore yourbloodtransfusion procedure.Proceedtoeither:
1. NorthTower- 4thfloor,Ambulatory Care Unit(ACU),Nurses'
Station,or
2. SouthTower- 1stfloor,OutpatientInfusion Services (OIS),
Room 151A
Parkingis available in thegarage located atCastro andDuboceStreets.
WhatCanIExpectDuringaBloodTransfusion?
Thenurse will ask youtosign aconsent formverifying thatyouunderstandand
agree totheprocedure as explained byyourdoctor.
Youwill bepositioned comfortablyfor thisprocedure.The nurse will insert an
intravenous line (IV)in yourarm.
Yourdoctormay ordermedication foryoutotake priortothe transfusion.The
nurse will explain thereason and actionof themedications.
For patientsafety, 2nurses will verify youridentity bycheckingyour I.D.band
withtheunit ofblood.
22. Thenurse will start thetransfusion andmonitor yourtemperature, pulse,and
bloodpressure before,during,andafter thetransfusion.
Also,thenurse will observe forsigns ofa reaction tothetransfusion(s).
Reactions tobloodtransfusionsare rare. Symptomsmay include shortness of
breath,chills or fever (101°F /38.3°C orabove),itching/hives, rash,nausea,
lower backpain,feelings ofapprehension,tingling ornumbness; heat,pain,or
swelling at IVsite.Please reportthesesymptoms immediately toyournurse.
Youmay eat anddrinkduringthis procedure.Withthe assistance of anurse, you
may getupandgotothebathroom.
WhatShouldIWatchOutforAfterI GoHome?
Youmay resume your normal activities.
Continue yourusual diet andmedications.
Be alert forsymptoms ofa reaction after yougohome. Call yourdoctor
immediatelyorgototheEmergencyRoomifyouexperienceanyofthe following
symptoms:
Shortnessofbreath
Chills orfever (101°F /38.3°C orabove)
Itching/hives, rash
Nausea
Lowerbackpain
Feelings ofapprehension
