Knowing Your Options
Blood transfusions are a critical part of everyday medicine. 4.5 million Americans receive blood each year.
Patients receiving organ transplants, cancer therapies and support for sickle cell anemia depend on lifesaving transfusions. Blood is also critical to the survival of premature babies and patients undergoing heart or joint replacement surgery.
Blood also plays a life-saving role in serious accidents, civil and military conflicts, and widespread tragedies, such as earthquakes and hurricanes.
To make sure blood is available for all patients who need it, healthy Americans should give blood as often as possible (every eight weeks) through their community blood center. If you are unable to donate blood yourself, encourage healthy family members and friends to do so to make sure the gift of life is there when it is needed.
Should you or a loved one require a blood transfusion, talk with your doctor about your options, possible risks and whether you might be able to donate your own blood for your operation.
Why would I need a blood transfusion?
You may need blood for a variety of reasons. Your body needs to replenish blood that is lost, destroyed or not replaced by your bone marrow, which makes your blood cells.
Loss may occur:
- during surgery;
- in an accident;
- as a result of cancer treatment or other illnesses that cause anemia. Anemia occurs when the body's red blood cell count is very low. Red blood cells carry oxygen from the lungs so that it can be used throughout the body.
Is it safe to get a blood transfusion?
The blood supply is safer today than it ever has been. Strict screening practices in the selection of donors, as well as federal safety requirements for the testing, storage and transportation of blood, make America's blood supply as safe as modern technology can make it. While America's blood supply is very safe, blood transfusions are not risk-free.
Only people who are not at risk for an infectious disease can give blood. Donors must answer a series of detailed questions about their health and risk for diseases that can be passed through the blood supply such as HIV (the disease that causes AIDS) and the hepatitis C virus (HCV). After completing the health questionnaire, donors take a mini-physical to make sure they are not anemic, have a fever or have high blood pressure. Each unit of donated blood (about one pint) goes through extensive testing to make sure it's safe for transfusion. If you think your health or behavior (such as using intravenous drugs or having multiple sex partners) may pose a threat to the blood supply, you should not donate blood. You also should not give blood to be tested for HIV, HCV or any other disease that can be transmitted through the blood supply.
In almost every case, the life-saving benefits of receiving a needed blood transfusion outweigh the possible risk of contracting an infectious disease. The risk of contracting HIV from a blood transfusion is about one in 1.5 million. That is much less than the risk of dying from a lightning strike. Thanks to new blood testing procedures, the chance of getting HCV is about the same.
Where does the blood for my transfusion come from?
Volunteer Blood Donors...
Non-paid volunteers give virtually all the blood needed in the United States for transfusions. Non-profit community blood centers use blood collected only from volunteer donors. The FDA requires that blood be labeled, stating whether a unit of blood has come from a volunteer or paid donor. Studies have shown that blood given by volunteers is much safer for transfusions than blood given by paid donors. Also, using blood donated by volunteers ensures that it was given only for altruistic reasons.
Other Options That May Be Available:
- Using Your Own Blood
- Directed Donation
- Apheresis Donation
Using Your Own Blood
Using your own blood, called autologous donation, reduces the chance of having a reaction to a blood transfusion. It also prevents you from getting a disease that may have been transmitted through the blood of others.
With your doctor's approval, you can donate your own blood up to six weeks before your surgery. Your doctors also can collect your blood during surgery and return it to your body at the end of operation. This procedure is called blood dilution or intraoperative hemodilution.
Depending on the timing of your surgery, the type of surgery and your personal health, these procedures may not be practical.
When it is not possible to donate your own blood, you may receive blood donated by volunteers at the community blood center. Because of the increasing safety of the volunteer blood donor supply, the effectiveness of autologous donations is being debated by the medical community. As a result, some insurance plans are limiting its use.
A directed donation is blood that is donated for you by family members or friends who have the same blood type as you.
There is no evidence that directed donations are safer than blood donated by community volunteers. In fact, blood donations from close relatives are more likely to cause a reaction by your immune system. In these situations, doctors must treat directed blood donations with radiation before it can be used safely.
An apheresis blood donation is blood that goes through a special machine to separate it during the donation so that only certain parts of the blood are collected. This allows more of one blood component, such as platelets, to be collected. For example, one apheresis platelet donation contains six to eight times more platelets than one whole blood donation.
Blood and Blood Components
Your medical situation will determine which blood component(s) you may need.
Red blood cells give your blood its red color. They also carry oxygen from the lungs to your body's organs and tissues and take carbon dioxide back to your lungs to be exhaled.
Platelets are very small colorless cell fragments in your blood whose main function is to stop bleeding. An average of four to eight units of platelets from whole blood donations (or one apheresis donation) is needed to meet one patient's needs.
Plasma is the liquid portion of your blood. Plasma transports water and nutrients to your body's tissues. Plasma also contains many proteins that help the blood to clot and fight disease.
White Cells or Leukocytes
White cells fight infection. In general, white cells provide no added benefit for a patient who needs a transfusion. Sometimes they can cause illness or transfusion reactions. In these instances, the white cells will be removed before a patient receives it.
Reducing Your Risks
For some patients, there are benefits to removing white cells entirely from blood.
More than half of all donated blood currently has white blood cells removed. This process is called white cell or leukocyte reduction. It may prevent a reaction to a blood transfusion and help some patients recover more quickly from surgery. Your doctor can tell you whether your condition requires white cell reduction. Because of the real and possible effects of white cells in blood transfusions, the U.S. medical and blood community is moving toward a time when all pints of blood and blood components will be leukocyte reduced.
I keep reading about blood substitutes - will they be available soon?
Despite much promising research, a true substitute for blood cells (that is, the red cells and platelets) will not be available for many years. More likely, blood transfusions will continue to become even safer because of improved blood donor screening and testing. In addition, scientists are exploring new technologies that can virtually eliminate infectious diseases from blood transfusions.
New drugs and medical techniques also can sometimes significantly reduce or eliminate the need for blood transfusions. For example, most surgeries today require far less blood than just a few years ago. In another example, patients on kidney dialysis who used to need monthly blood transfusions, now take a drug that promotes red cell production in the body and almost eliminates the need for a blood transfusion.
If nearly all blood comes from volunteers, why is there a charge to hospitals?
While blood is donated at no cost by volunteers, blood centers charge a fee to cover the costs of recruiting blood donors and collecting, testing and distributing blood to hospitals. These "service fees" also apply when you're donating blood for your own use.
Hospitals also charge a fee for laboratory work, which makes sure the donated blood matches your blood type and for the transfusion procedure itself.
Before you or someone you love receives a blood transfusion, talk to your doctor about the options. Your doctor can tell you which options are appropriate for you and can provide you with additional information about your transfusion.