Blood transfusion

Blood Transfusion is a essential part of modern healthcare. It is not limited to Haematology patients but is overseen by a transfusion team, led by a haematology consultant, that includes doctors, nurses and lab staff. This team are responsible for developing the policies and procedures, providing training and monitoring practice use to ensure that all transfusions given at the James Paget are as safe and effective as possible.

Components provided

When a unit is donated it is processed by NHS Blood and Transplant to provide the following components, all of which are transfused at the James Paget University Hospital

Red cells: Red cells carry an iron based protein called haemoglobin. Haemoglobin transports oxygen from the lungs to the organs and tissues, and carries carbon dioxide back to the lungs to be exhaled. Red cells are required for various reasons – for example blood loss, anaemia, bone marrow disease or chemotherapy. In some cases it can be avoided - see alternatives below - but in many cases it is essential for life to continue. 

Platelets: Platelets are small cells that are involved in the clotting process. If you don’t have enough platelets minor bleeds (for example a simple nosebleed) can become major as the normal clotting process fails. Platelets are given either prophylactically to prevent bleeding or therapeutically when bleeding is happening.

Fresh Frozen Plasma: Fresh frozen plasma contains clotting factors. It is used during massive bleeding, alongside red cells, to help replace clotting factors that are being used up rapidly. It can also be used in some specific cases to improve coagulation prion to a surgical intervention.  

Cryoprecipitate: Cryoprecipitate mainly contains fibrinogen, another essential part of the clotting process. It’s use is mainly restricted to massive bleeding because of the development of specific fibrinogen factor that are virally inactivated and can be used to correct fibrinogen deficiency.

White cells: White cells are rarely used at the James Paget – they are given to patients whose haematological disease means they have few or no white cells of their own and they have an infection that is not responding to antibiotics.

Alternatives

Cell Salvage: During surgery blood loss can be collected, treated and transfused. Using cell salvage reduces (and sometimes replaces) the need for a transfusion. If you are having surgery ask your consultant if this could be a suitable alternative.

Intravenous iron: Anaemia due to iron deficiency is fairly common – in most cases oral iron supplements are enough to support the bone marrow to produce extra red cells. If there are absorption problems, or replacement red cells are required rapidly, intravenous iron can be given rather that a transfusion of red cells. Your consultant will discuss this with you as part of the consent process.

Risks

Transfusion is not without risk although we have many processes in place to make it as safe as possible. Some of the risks and how we mitigate them are described below

Incompatible unit given: Throughout the process, from sample collection through to administration, you will be asked to confirm your name and date of birth numerous times. This is then compared to our record to ensure that, ultimately you will receive the correct unit. As an inpatient or in day care units you must be wearing a wristband if you are having a transfusion.  If you are not asked to confirm your identity and do not see your wristband being checked against records please speak up.

NHSBT and the Hospital lab also have numerous safety measure in place to prevent accidental issue of an incorrect unit.

Respiratory complications: The commonest respiratory complication is known as Transfusion Associated Circulatory Overload (TACO). You will be assessed for your risk of developing this and your consultant will discuss this with you during the consent process. There are other complications caused by other antibodies. These cannot be predicted but can be effectively treated.

Infections: Units can become contaminated. All precautions are taken from donor selection, storage conditions and a final check of components before transfusions are given to prevent this, hence it is exceedingly rare. There are also certain diseases that can be spread through blood donor unit selection, and thorough testing for the presence of common diseases (eg Hepatitis B, HIV) ensures that this is also a rare occurrence.

Allergic reaction: An initial allergic reaction cannot be predicted. There are steps that can be taken once we are aware that you have allergies. Throughout your transfusion you will be monitored for any sign of reaction, and you will also be asked to raise an alarm if you feel unwell or unusual during the transfusion.    

More information

If you want more information you can discuss this with your consultant or alternatively please visit the NHSBT web site; https://www.nhsbt.nhs.uk/