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A guide to good blood: the truth about transfusions

A guide to good blood: the truth about transfusions
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First Published: Mon, Feb 23 2009. 11 21 PM IST

Updated: Tue, Feb 24 2009. 10 29 AM IST
Every major surgery means multiple visits to the blood bank by the patient’s kin. Injuries and accidents too necessitate transfusions. Blood donation drives are the popular way of collecting blood.
And yet many critical facts about blood transfusion are not common knowledge; myths about this basic life-saving procedure still abound.
Myth 1: Family is best
The World Health Organization (WHO) advocates that its member states develop national blood transfusion services based on voluntary, non-remunerated, regular blood donation in accordance with the world health assembly Resolution 28.72, adopted in 1975.
Despite this, family and paid donors, who are associated with a significantly higher prevalence of transfusion-transmissible infections (TTIs)—including HIV, hepatitis B, hepatitis C, malaria and syphilis—still provide about 50% of the blood collected in developing countries.
What you can do: Play your part by taking responsibility and donating regularly yourself (see Myth 4). Take part in the next drive.
Myth 2: Fresh is best
Blood transfusion is not—and should not be, for reasons of safety—an instantaneous process (see KNOW below). “Fresh blood” means the proper safety procedures—which take long enough to require cold storage—may have been bypassed.
Blood testing is not just a matter of matching. All donated blood should be tested for TTIs, recommends the Central Drug Standard Control Organisation (CDSCO). The presence of irregular red cell antibodies must also be checked before transfusion, in order to avoid serious haemolytic reactions. Besides these, an individual donor-nucleic acid amplification test (ID-NAT) helps to detect TTIs by narrowing the time window for HIV and hepatitis B and C testing, which can be detected by a routine ELISA procedure but takes longer (this test is not mandatory, however, so do ask if you have cause for concern).
What you can do: Acquire the blood components from licensed and reputed blood banks only. This is not something you should take chances with.
Myth 3: Good blood is whole blood
In India, the common practice is to take blood from a donor, which is then transfused whole into the patient. Usually, the specific component that a patient requires (whether red blood cells for a haemoglobin boost or platelets to help clotting) are not isolated for transfusion.
However, international norms of good clinical practice supported, among others, by the National AIDS Control Organisation (Naco), recommend that blood should be separated into its various cellular components—such as red blood cells (packed red cells), platelets and plasma components (fresh frozen plasma, cryoprecipitate, coagulation factors, immunoglobulins, etc—see REMEMBER). It is well known that routine blood transfusions can cause a number of immediate as well as long-term adverse effects, most commonly because of white blood cell (WBC) contamination. As per international blood safety recommendations, WBC content should be removed before transfusion. Special blood collection bags with diversion pouches can be used during blood collection to minimize contamination risks. And, as a matter of fact, experts agree that there are very few circumstances for whole blood transfusion.
When whole blood is given to, say, raise haemoglobin levels, it implies transfusing unjustified amounts of liquid plasma into the patient, thereby adding to the risk of transfusion hazards. Optimization of blood transfusion through component therapy not only helps reduce blood shortages, avoiding the transfusion of white blood cells can even prevent complications such as febrile reactions.
Another advantage of component therapy of course is that more than one patient can be treated with blood components derived from a single donation.
Myth 4: A blood donor is a weary do-gooder
A normal adult has about five litres of blood in his body and can safely donate 10% of it, with no ill effects whatsoever, including weakness. Typically, you are invited to donate just 350-450ml, depending on your weight. And that tiny loss of blood volume can be made up by a healthy donor in as fast as a day.
The occasional feeling of dizziness after donation is usually caused by the small drop in blood pressure and also by getting up too fast, and can well have a psychological component to it if the donor is anxious.
Also, “healthy” donor has a wider range of parameters than popularly supposed. For instance, many experts believe a menstruating woman can safely donate blood as long as she feels fine (of course, that rules out anyone with excessively heavy periods or debilitating cramps). Similarly, a smoker or habitual marijuana user is no doctor’s idea of “healthy”, but is fit to be a donor unless suffering actual illness or warning symptoms. Someone with a skin rash can donate as long as the needle doesn’t puncture affected skin; so can someone who is overweight.
On the other hand, if you’ve had a piercing, tattoo or certain cosmetological treatments, it may be a good idea to wait a year if you’re not 100% sure the instruments used were sterile and non-contaminated.
Myth 5: Every sinking patient needs a shot in the arm
Not every patient who complains of feeling weak, being anaemic or has low blood pressure will necessarily be set right by a blood transfusion. It is true that weakness and anaemia can indicate a need for a blood booster—but there may be other problems that need setting right first (an internal haemorrhage, for instance, will continue blood loss and transfusion will not help until that is sorted out). In other cases, the causes of weakness and anaemia can be treated directly and will slowly reverse the symptoms without needing a blood transfusion. Exertion and shock can leave a person fatigued, say, after childbirth or a traumatic experience: Neither is an indicator for a blood transfusion (see Ask the doctor).
Ask the doctor (or the nurse)
Is a transfusion really necessary?
No transfusion is without risk. A transfusion gone wrong can be life-threatening. Therefore, understand the risks and benefits of various blood component transfusions and transfusion alternatives. If a blood transfusion is given when not required, the patient does not benefit but is exposed to unnecessary risks. In addition, unnecessary or inappropriate blood transfusion may create a shortage of blood or blood component for patients in real need.
Won’t just one blood component do?
When platelets are required, why pump in red blood cells or plasma? When plasma is required, it is advisable to avoid transfusion of cellular components such as red blood cells or platelets. Because not only is the whole process rather wasteful when blood banks are often struggling to replenish stocks, it can even be counterproductive (see Myth 3).
Where will the blood be obtained from?
How will it be transported? You need to make sure the blood comes from an accredited blood bank, so that you can be sure it has been tested adequately for infections, contamination as well as compatibility (see Myth 2 and ‘KNOW’ below). Also, for a safe, successful transfusion, the blood bags should arrive from the bank in special boxes designed for transportation of blood products.
It also helps to check whether the blood bank is following international quality standards and guidelines issued by organizations such as the European Council, American Association of Blood Banks and National Aids Control Organisation, besides the minimum standards specified by the Drugs and Cosmetics Act.
Blood components that can be separately transfused :
Red blood cells (RBCs): These are administered to treat anaemia resulting from kidney failures, gastrointestinal bleeding and acute blood loss resulting from trauma
Platelets: These are cell fragments in the blood responsible for stopping bleeding. They are given to counter decreased platelet counts (from chemotherapy, for example, or dengue)
Plasma: This component consists of 90% water and 10% plasma proteins, and is often given in cases of clotting disorders
White blood cells (leukocytes): They are the disease-fighting cells in the blood, but can also be problematic. A transfusion is sometimes needed by newborns with severe infections; otherwise, similar conditions in older patients can now be treated with white cell growth factors.
Getting a blood transfusion is a simple enough medical procedure but the process can be time-consuming if safety is to be ensured.
When a patient needs a transfusion, a tiny volume (3-5ml) of his blood is sent to a blood bank. There it is grouped for ABO and Rh factors, screened for irregular antibodies and compatibility-tested against stored blood from preferably the same group, or a compatible type. If no adverse reactions occur, it is considered a suitable match and is sent across to the hospital. Transfusion of the contents of a single blood bag generally takes 3-4 hours.
India has made some progress in providing safe drinking water and basic sanitation over the last decade, but problems of low overall calorie intake and chronic energy deficiency have hardly been tackled, according to a new report. The report on the State of Food Insecurity in Rural India, prepared by the MS Swaminathan Research Foundation (MSSRF) and the UN’s World Food Programme, noted some improvements with regard to stunting (due to poor nutrition) among children. The most serious problem, it noted, has been an increase in the prevalence of anaemia.
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First Published: Mon, Feb 23 2009. 11 21 PM IST
More Topics: Surgery | Blood bank | Patient | Injuries | Accidents |