Why would I need a transfusion?

Some patients may need a single, emergency transfusion after an accident, major surgery, or some other cause of blood loss. Others may have an illness where blood products are required frequently during their treatment eg. Patient with kidney disorders, blood disorders or having treatment of cancer. The type of blood product you need will depend on your illness or injury.

What do you mean by blood products?

Blood contains many components that perform different functions, it is not whole blood but a blood component or product that is given.

Red Blood cells
Carry haemoglobin that deliver oxygen to your tissues and organs. Red Cells are usually given if haemoglobin levels are low (anaemia) or if a lot of blood is lost.

Platelets
are cells that help stop bleeding. Some diseases, medications or treatments can lower the number of platelets. This product is yellow in colour.

Fresh Frozen Plasma and Cryoprecipitate
Contain clotting factors that work with platelets to seal wounds. Many clotting factors are individually manufactured,
but if unavailable than these blood products / components may be required. These products are also yellow in colour.

“Is the blood safe?”

People worry about the side effects of blood transfusions, but in our hospital blood products are donated by people who are very carefully screened for blood borne viruses, Human Immunodeficiency Virus (HIV), Hepatitis B and C (HBV and HCV), and also for Malaria and Syphilis. People known to have been exposed to certain transmissible infections or viruses are not allowed to donate blood.
Despite testing, a very small risk of disease transmission and other side effects remains. The current risks are

• HIV (AIDS)
• Hepatitis C
• Hepatitis B
• Incompatible Blood

If I don’t want a blood transfusion, what else is there? Are there any alternatives?

In some emergency situations there are no alternatives and refusing a transfusion would endanger your life. But in other cases, where there is a planned surgery, mild blood loss or long-term blood use, there are alternatives. Some alternatives include:

Tolerating a low blood count
If you are generally fit and healthy with no heart problems, then you may tolerate a low blood count quite well. The most likely symptom possible to experience is a little tiredness. Your own count will recover then over a few weeks as your body makes new cells. Some patients with chronic illnesses also tolerate lower counts as their bodies and  lifestyles adjust to these lower counts.

Having your own blood collected prior to surgery for use after surgery
This is called autologous donation and transfusion. If your own blood is used you still need to undergo some medical checks to see if you and your blood are suitable as specific donation criteria apply.

Preoperative Hemodilution
Whole blood is collected from patients after they have been anaesthetized and immediately prior to surgery. Simultaneously a replacement solution is infused to maintain your blood volume. Your own blood is then used during or after surgery before you leave the operating suite.

Intraoperative Cell Salvage
Here blood is collected during surgery into special drains and containers and then transfused back to you.This is an
expensive alternative which involves latest equipments and use of various consumables.

Volume expanders
They are intravenous fluid solutions that are used to increase the volume of fluid in the circulating blood. The result is that when a patient bleeds during surgery, the diluted blood contains a lower concentration of red blood cells. They do not carry oxygen, but they enable the heart and circulatory system to carry red blood cells around the body.

Plasma expanders
These are used to increase (expand) the volume of plasma in the blood. They are mainly used in medicine to replace fluid in cases of severe shock, as may occur with blood or fluid loss in surgery. Examples include Haemaccel, Albumex, Gelofusine.

Do I have to give my permission before getting any blood?

Before any medical procedure is carried out, you will be asked to give permission. A family member designated by the patient may also decide on behalf of the patient. You should be given enough information to make you feel comfortable that you are making the right decision. If there is anything you don’t know or understand, be sureto ask your doctor. In an emergency, there may not be time to discuss your treatment. However, the reasons for the transfusion should be explained to you when you are recovering.

What happens first?

First your doctor writes a form requesting tests for your blood group and to find out what antibodies you have in your blood. This usually occurs during one of your consultations. You may be group O, A, B or AB. You may also be either positive or negative for the Rhesus factor. When this is determined, your blood is also tested for other antibodies that needs to be matched to the donar blood.

Sometimes before surgery your doctor may order your blood to be “grouped and screened” for these other antibodies so that blood can be supplied at short notice if you need it. This does not mean you will necessarily have blood, but there is a possibility that you will. Therefore you should ask the doctor all your questions as to why you may need it and what the risks of having a blood transfusion are, so that you are prepared.
This is a time to also inform your doctor of any religious, physical or lifestyle reasons why you may not wish to have ablood transfusion.

A blood sample is taken from your vein by a nurse after verification of full name and UHID so that your blood group can be determined. She / He may also ask you to spell out your name to ensure your correct spelling goes on the blood sample. There may be other patients with very similar names to yours.
Even if you are known to the staff, this accurate identification is a vital step that should not be missed.

How do I receive the blood?

Two nurses will check the products at your bedside, asking you again to state your name and verify the same and UHID with the hospital provided wristband.
Because there are many people with similar names, all details must match exactly or the blood product cannot be commenced. Even though you may be known to the staff, this step is too important to skip over. The labels on the unit of blood product will also be checked carefully against details on your wrist band and the
accompanying Blood bank paperwork.

How long does it all take?

Red cells usually take between 2 and 4 hours per unit to give, platelets usually 20 to 30 minutes per unit and plasma also 20 to 30 minutes per unit.
They can be given as fast as you can safely tolerate, but cannot take longer than 4 hours. After 4 hours the unit must come down, and if you need more, a fresh unit will be obtained.

How will I feel during that time?

As in all medical treatments, there will be side effects that may occur during or after the blood product transfusion.
Symptoms may include:

• Hot, flushed / cold, chills
• Nausea, vomiting
• Blood in your urine
• Light headedness, dizziness
• Rash, hives
• Shortness of breath
• Back pain

Your nurse will keep a close eye on you during the transfusion – taking your temperature, pulse and blood pressure before you commence the transfusion and several times during the transfusion.
If you feel un well at any time, please notify the nurse, even if she / he has just seen you.
Be sure to ask if you would like more information or if you are not sure of something at any time during your  transfusion.

Answering these questions will help you to make sure you have received enough information.

• Do not understand why you need the blood products?
• Have the possible risks been explained to you in a particular situation?
• Have any alternatives been explained to you?
• Have all your questions been answered?