Blood transfusion - patient information

Uploaded by SunnybrookMedia on 15.02.2012


My name is Jeannie Callum and I'm a transfusion medicine physician at
Sunnybrook Health Sciences Centre and University Health Network. You've been asked to view this video today
as your physician is recommending transfusion as part of your treatment plan. This video
will cover the process of transfusion, the benefits, the risks and alternatives.
After the video, your physician can answer any other questions you have.
First we are going to review the benefits of transfusion. There are two different kinds of blood products that we commonly use
red blood cells and platelets. Red blood cells carry oxygen
and when your red blood cell level, or hemoglobin, level drops either from your cancer
or blood problem, or from the treatment for your condition, you may feel short of breath
when you walk, lightheaded or dizzy
or you may feel your heart racing. These are symptoms that tell us your body is not getting enough oxygen.
This is usually when your hemoglobin level drops below 65 to 90
but may vary from person to person. Ask your nurse or physician
where your blood level is today. Red blood cell transfusions will relieve these
symptoms and make you feel better. The second kind of blood product is platelets. Platelets are
cells that stop you from bleeding. If your platelet count drops
to a very low level, usually below 10, or you have bleeding, such as nose bleeds,
your physician may recommend platelet transfusion.
Now let me describe the process of having a transfusion. If you decide to have a
blood transfusion, your physician will ask you to sign a consent form for blood transfuion.
By signing this form, you are stating you understand the benefits, risks and alternatives
to blood and that you've had all your questions answered. Please make sure
you ask all the questions you need to feel comfortable about making this decision.
Next, you will have a blood sample drawn to determine your blood type.
The blood transfusion lab will also check to see
antibodies to blood. Patients may develop these antibodies, an immune reaction
after exposure to either the baby's blood during pregnancy, or
to a previous transfusion. For safety reasons, the blood
bank requires your blood group be tested twice on two separate occasions before
blood can be issued. This allows us to be confident about your blood type.
The blood bank will then select a unit for you and label it with your name
hospital file number and your date of birth. A crossmatch is performed to ensure
the blood group of the donor is compatible with you. The transfusion will
take place in the transfusion medicine clinic. There is nothing special you need to do
on the morning of your transfusion. You can eat normally and take all your regular medications.
Each unit of blood will be run over two to four hours
depending on how fast the blood can be run. Patients with heart problems must have
their blood transfusion run slowly to prevent breathing problems.
As soon as you arrive in the tranfusion clinic, the nurses will start an intravenous. The
nurses will take your temperature, heart rate and blood pressure before starting
the transfusion. The nurses will check the blood with either a computer
barcode reader, or with a double check by two nurses to ensure you get the right
unit with your name on it. Please also review this label before
the transfuion is started. The nurse will then start the transfusion.
Other than a slight cool feeling as it begins, you should not feel anything else.
The nurse will run the blood slowly for the first 15 minutes, looking for any reaction.
At 15 minutes, the nurse will recheck your temperature
heart rate and blood pressure. If there are no changes, the nurse will increase the rate
of infusion to complete the transfusion of each unit up to two to four hours
depending on the rate set by your doctor. Most patients need one or two
units or bags of blood at each visit. There are two common
minor reactions that we see during transfusion that cannot be avoided.
About 1 in 100 patients develop hives, which is a type of itchy rash.
This is a minor allergic reaction that almost always goes away with antihistamines
and then the transfusion can be continued. At the first sign of itchiness
please let your nurse know so that we can give antihistamines and prevent widespread itchiness.
The second type of reaction is a fever. It happens
in about 1 in 300 transfusions. The blood cells in the blood products
sometimes release flu-like hormones that can cause fever. These reactions usually go away quickly with medications
acetaminophen, commonly known as Tylenol.
Please let your nurse if you start feeling feverish or have chills.
You should not feel any other symptoms during your tranfusion.
If you feel anything unusual during or even in the few days after the transfusion
immediately notify your nurse or physician.
Now we're going to review the risks of having blood transfusion. All blood you're going to receive is going to come from
unpaid volunteer blood donors from Canadian Blood Services. Numerous steps
ensure that the risk of having a blood transfusions is as small as possible.
The donor is asked to answer questions about their health and medical history.
Then the donor is taken into a private room with a nurse to ask questions
about high risk behaviour for HIV and hepatitis. The nurse will also check
the donor's temperature, heart rate and blood pressure.
To minimize the risk the risk of bacteria entering the blood product, the donor's arm is thoroughly cleaned.
Also, the first few tablespoons of blood is used for testing
further reducing the risk of bacteria entering the blood bag.
The blood is tested for HIV, hepatitis B and C, syphilis, west nile virus,
a virus that causes leukemia, and a blood parasite common in South America.
Despite this testing, there is still a remote risk of these infections from blood
as shown on this slide. This is because there is a short
period between when the donor becomes infected and when these tests become
positive. For example, these is about ten days for HIV.
The risk of HIV from a blood transfusion is estimated at
1 in 7.8 million donations. In Canada, we transfuse
just under 1 million blood units per year. This means, that once every seven
years, someone might get HIV from a blood transfusion in the whole of Canada.
The statistics suggest that you are more likely to be struck by lightning this year
than to develop HIV from a blood transfusion.

There are five transfusion complications
that you need to know about. First, some patients that are older or with heart
conditions can develop heart failure from a blood transfusion. Your physician will prescribe
a diuretic or water pill and slow the transfusion down
if you have a higher risk of this complication. Heart failure will cause you to feel short
of breath during or after a transfusion. Second, you need to
know about the risk of lung injury from transfusion. This risk is approximately
1 in 10,000 tranfusions
their immune system reacts with your lungs and causes them flood with water
and the reaction is usually transient and thought to be less
common in patients having outpatient transfusions. Rarely, patients require
artificial lung support for a few days after this reaction.
Sometimes patients develop breakdown of their red blood cells due to incompatability
a type of immune reaction. Accurate testing by the blood bank has reduced this
risk to only 1 in 40,000 transfusions. Fever, felling unwell and red urine
are the first signs of such a reaction. Let your nurse or
physician know immediately, even if this reaction happens after you arrive home.
Fourth, severe allergic reactions such as those seen from peanut
allergy are rare but can happen. They happen shortly after the transfusion
is started and your nurse will be watching for this. Lastly,
units of blood can become infected with bacteria despite our prevention strategies.
This risk is 1 in 10,000 from platelets and 1 in a quarter million for red blood cells.
Your nurse will be looking for signs of this in your heart rate,
blood pressure and temperature., This is managed by stopping the transfusion
and giving intravenous antibiotics. Lastly, we're going to discuss
alternatives to blood transfusion. Unfortunately, despite years and years
of research, scientists have been unable to develop an artificial source of blood
cells. There are two alternative treatments you should discuss with your physician:
iron and erythropoietin, which is a type of blood hormone. Iron can be safely
given both by mouth and intravenous infusion. Your physician
can tell you your iron level and whether you would benefit from iron.
Erythropoietin is commonly used in patients with blood disorders, but its use in patients with cancer is controversial.
Studies suggest this drug may increase
the risk of cancer recurrence and blood clots. We therefore try to avoid
its use in patients having cancer treatment where there is a possibility of cure.
When we do use it, we use the smallest possible dose that avoids
tranfusion. We don't know which treatment, erythropoietin or tranfusion
is the safest option. We believe that the risks are similar, but have no large
studies directly comparing these two treatments to know for sure.
Ask your doctor if erythropoietin is an option for you. This therapy
is given by weekly injection just under the skin and can be given at home.
This therapy is expensive at a cost of approximately 450 dollars per dose.
It is covered by most drug plans and for patients
over 65 who have advanced cancer who are on chemotherapy.
Now that we've covered the process of having a transfusion, the benefits and risks
of transfusion and the available alternatives, please be sure to discuss
with your nurse and physician any further questions you may have. We want to make sure
that you have the information you need to make this very important health decision. If you would like
more information about transfusion, please visit the Transfusion Ontario
website at