Red blood transfusion

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Why do patients need blood transfusions?
Blood transfusions are given to replace blood lost in surgery or to treat anaemia (lack of red blood cells).

If you have anaemia, your body does not have enough red cells to carry the oxygen you need. You may feel tired or breathless (see coping with fatigue). A detailed illustration of what happens to the body when you are anaemic can be found on the Strength for living web site (highly recommended). Blood transfusion is an effective treatment where a speedy improvement is needed. Treatment by iron, medicines and vitamins may be effective when treatment is less urgent. Your doctor will only recommend that you have a blood transfusion if you really need it.

Is blood safe?
In the United Kingdom, all blood donors are unpaid volunteers who are carefully questioned about their health. Before donation, every effort is made to identify and exclude those who may be at risk of passing on infections. In addition, every unit of donated blood is individually tested. Any blood which fails these rigorous tests is discarded and the donor is advised. The testing process is regularly monitored to ensure that the highest standards are maintained.

In recent years, people have become aware that viruses, including hepatitis B and C, may very rarely be passed on in blood. This may happen even more rarely with HIV - the virus that causes AIDS. In considering the risks of transfusion, it may be helpful to know that many common activities (e.g. smoking or driving a car) carry far greater risks of death or serious injury.

The chance of contracting AIDS from a blood transfusion in the UK is less than 1 in 2,000,000. This is classified as a negligible risk, of the same order as the chance of being struck by lightning. The current risk of a blood donation being infected with hepatitis B or hepatitis C is 1 in 200,000. There is no proven or even probable instance of transmission of CJD by blood, blood components and blood products. In comparison, the risk of dying while playing soccer is 1 in 25,000 (i.e. at least 80 times more likely than being infected with HIV and 8 times more likely than being infected with hepatitis B or hepatitis C). The risk of dying in a road accident is approximately 250 times greater than the risk of AIDS from a blood transfusion, and 25 times greater than the risk of catching hepatitis B or hepatitis C.

The risks of having a blood transfusion must always be balanced against the risks to your health of not having a blood transfusion.

Can I have a reaction to someone else's blood?
There are many blood groups which differ from person to person. Before a blood transfusion is given, a blood sample will be taken to match your blood with a suitable blood donor. This will reduce any chance of reaction, which may include fever or chills. Having a reaction to blood does not mean that the blood is infected. It usually reflects the fact that your body can recognise blood from someone else.

When selecting blood for transfusion, it is impossible to match a donor's red and white blood cells exactly with those of a patient, as there are far too many blood groups to match. Therefore, only the two most important blood groups are taken into account. Some months after a transfusion, a few people (about 8 - 10%) may develop antibodies to minor blood groups in donor blood. These antibodies will not make the person feel ill in any way, but will be identified if blood tests are done in the future. These tests will help decide what sort of blood should be given next time around.

Can I donate my own blood before an operation?
For certain operations, it may be possible to donate two or three units (1 unit = approx. three quarters of a pint) of your own blood three to four weeks before admission to hospital. Of course, not everyone is able to do this; giving blood may make some people feel unwell and it is inadvisable if you have problems such as high blood pressure or an infection. Your doctor will be able to advise you.

What if I have other concerns?
You may be worried about such things as feeling squeamish at the sight of blood or of having a needle put in your vein. The doctor or nurse can help with these concerns. They will not see them as silly or of no importance.

Where can I get further information from if I need it?
If you require further information, please ask the doctor or nurses on the ward or in the clinic.

If you wish to become a blood donor please contact (UK) 0345 711 711

Alternatives to blood transfusion
An alternative method to correct anaemia is to inject  a hormone called Epoetin alpha (EPREX). Eprex is the purified form of the signal chemical from the kidney's to the bone marrow called erythropoetin. Regular administration of eprex overcomes the  kidney's failure to pick up the low levels of oxygen in the blood stream by directly stimulating the bone marrow to make more red cells.  Eprex has been used in many cancer patients (and those with renal failure) in the United Kingdom and throughout the world.

Both blood transfusions and eprex are successful in correcting anaemia. Early trials suggest that eprex has an advantage of improving the energy levels and quality of life over the whole chemotherapy course compared to blood transfusion. Ongoing trials are underway to confirm this and establish its cost against blood transfusion.