Blood Transfusions

Like all medical treatments, a blood transfusion should only be given if it is essential. Your doctor or nurse will balance the risk of your baby having a blood transfusion against the risk of not having one. They will explain to you why your baby needs a blood transfusion, but please ask if they do not. They should also explain the risks and any possible alternatives before gaining consent for the procedure.

Will I need a blood transfusion?

Why might I need a blood transfusion?

Blood contains many different cells. The red cells are essential for carrying oxygen around the body. A lack of these red blood cells is called anaemia.

A blood transfusion may be given because of a shortage of red blood cells in the blood, either because the body is not making enough of them or because of blood loss.

Sometimes the bone marrow, which produces blood cells, fails to work properly and is unable to make enough of them. This may be due to disease or as a result of treatments, such as chemotherapy. It may be temporary or longer term. In some cases anaemia can be treated with medicines such as iron; in other cases, a blood transfusion may be the best option.

Most people can cope with losing a moderate amount of blood without needing a blood transfusion, as this loss can be replaced with other fluids. However, if larger amounts of blood are lost, a blood transfusion may be the best way of replacing blood rapidly. A blood transfusion may be needed to treat severe bleeding, for example during an operation, during or after childbirth or after a serious accident.

Is a blood transfusion my only option?

Certain medical conditions causing anaemia may be managed by treating the cause rather than by giving a blood transfusion. If you are told that you might need a blood transfusion, you should ask why it is necessary and whether there are any alternative treatments such as iron therapy.

You have the right to refuse a blood transfusion but you need to fully understand the consequences of doing so. Some medical treatments or operations cannot be safely carried out without a blood transfusion.

Blood transfusion is only needed for a small number of patients having an operation. It may be possible to recycle your own blood during an operation, ask your healthcare professional if this is appropriate for you. Sometimes medicines which improve blood clotting, such as Tranexamic acid, can be used to reduce blood loss and the need for transfusion.

What can I do to reduce the need for a blood transfusion before an operation?

Low iron levels can cause anaemia therefore, it is important that you eat enough foods containing iron. A varied and balanced diet should normally provide an adequate iron intake. A leaflet called ‘Iron in your diet’ is available from NHS Blood and Transplant, which gives further advice on this. Please ask your healthcare professional for a copy of this.

Depending upon the type of operation you are having, your healthcare professional will arrange for a blood sample to be taken several weeks before your operation to see if you are anaemic. A shortage of iron can cause anaemia and correcting this in good time, before your operation, may reduce the need for a blood transfusion.

Some medicines, such as warfarin, other anticoagulants, aspirin, clopidogrel and some anti-inflammatory drugs may increase the risk of bleeding during your operation. Always check with your healthcare professional to find out if you should stop taking these before your operation and if so, when you should restart them. Do not stop taking any medications without consulting a healthcare professional first.

Risks associated with a blood transfusion

The risk that a blood transfusion will cause severe harm or even death is very low but this should be discussed with your healthcare professional. One of the most important checks for a safe transfusion is to make sure you get the right blood. You can help reduce the small risk of being given the wrong blood by asking your healthcare professional to check that it is the right bag for you.

You must be correctly identified at each stage of the transfusion to make sure that you get the right blood, including when blood samples are taken before the transfusion. If you are an in-patient, wearing an identification band with your correct details is essential. You will be asked to state your full name and date of birth and this will be checked against your identification band. If you have your blood samples taken as an out-patient, you will not usually be given an identification band to wear, but it is still important that the staff ask you your full name and date of birth to confirm they are taking the samples from the right person. It is alright to remind the healthcare professional to ask you for this information.

If you have a card that states that you need to have blood of a specific type, please show it as soon as possible to your healthcare professional and ask them to tell the hospital transfusion laboratory.

Compared to other everyday risks, the likelihood of getting an infection from a blood transfusion is very low. All blood donors are unpaid volunteers and the risk of an infected unit entering the UK blood supply continues to decrease. Donors and blood donations are screened for a number of infections which can be transmitted through blood, but it is not practical or even possible to screen all donations for all infections, therefore, there will always be a small risk associated with having a blood transfusion.

The risk of getting variant Creutzfeldt-Jakob Disease (vCJD) from a blood transfusion is extremely low. Each year, approximately 2.6 million blood components are transfused in the United Kingdom and there have been only a handful of cases where patients are known to have become infected with vCJD.

More information on vCJD can be found on the NHS Choices website:www.nhs.uk

Further information on the risks of transfusion can be found at:www.shotuk.uk

How will my blood transfusion be given and how will I feel?

A blood transfusion is usually given through a tiny tube directly into a vein in the arm. It may take up to four hours to give each bag of blood, but it can be safely given more quickly if needed. You may be given more than one bag of blood as part of your treatment.

Most people do not feel anything unusual during a blood transfusion. You will be observed before, during and after your blood transfusion; if you feel unwell during or after it you should inform your healthcare professional immediately. Some people may develop a temperature, chills, a rash or breathing difficulties. These reactions are usually mild and are easily treated with medicines such as paracetamol and antihistamines, or by slowing down or stopping the blood transfusion. Severe reactions to blood transfusions are extremely rare. If they do occur, staff are trained to recognise and treat them.

What if I have worries about receiving a blood transfusion?

If you are worried or have any questions, please talk to your healthcare professional. Many hospitals have a dedicated Hospital Transfusion Team and if appropriate, they may be able to come and discuss your concerns with you.

Patient Blood Management (PBM)

PBM is a standard of care that focuses on measures to reduce or avoid the need for a blood transfusion if possible. However, if a transfusion is needed, it makes sure that patients are given only what they really need and that the transfusion is given safely. There is a NHS Blood and Transplant (NHSBT) PBM Patient Information Leaflet available that explains things in more detail so please ask your nurse or doctor for a copy.

Recent studies suggest that if PBM is followed and transfusion is reduced or avoided, patients have fewer complications, faster recoveries and shorter stays in hospital.

During your treatment, a transfusion of platelets or other blood component such as fresh frozen plasma may be required. If so, there are other patient information leaflets available from NHSBT such as “Will I need a platelet transfusion?” that may help explain things for you. Please ask your healthcare professional for a copy of the other leaflets that are suitable for your proposed treatment pathway.

Additional Information

As a precautionary measure to reduce the risk of transmitting vCJD, people who have received a transfusion of blood or any blood component since 1980 are currently unable to donate blood or blood components.

Further information on Iron, Anaemia and Patient Blood Management is available in other patient information leaflets. Please ask your healthcare professional if you would like a copy of these.

You may also find the following websites useful:

www.nhs.uk

www.nhsbt.nhs.uk

Will my baby need a blood transfusion?

Why might my baby need a blood transfusion?

Newborn babies frequently become anaemic (have a reduced number of red blood cells), particularly if they are born early. This may be because of medical problems, or because babies who are unwell require a large number of blood tests to monitor their progress and this needs to be replaced. Occasionally, babies who are very jaundiced or anaemic need to have blood removed as well as transfused; this is called an exchange transfusion.

If your baby needs an operation, a blood transfusion may be needed to replace any blood lost during surgery.

Risks associated with a blood transfusion

The risk that a blood transfusion will cause severe harm or even death is very low but this should be discussed with the doctor or nurse caring for your baby. One of the most important checks for a safe transfusion is to make sure your baby gets the right blood. To ensure this happens, staff carry out careful identification checks of both your baby and the blood they will be given. This is why it is important that your baby wears an identification band. If you are with your baby, you may also be asked to confirm your baby’s full name and date of birth. Please remind the nurse or doctor to ask you this if they do not do so.

If you decide to change your baby’s name for any reason, it is important to tell your doctor or nurse, so that your baby’s records can be updated.

Compared to other everyday risks, the likelihood of getting an infection from a blood transfusion is very low. All blood donors are unpaid volunteers and the risk of an infected unit entering the UK blood supply continues to decrease¹. Donors and blood donations are screened for a number of infections which can be transmitted through blood, but it is not practical or even possible to screen all donations for all infections, therefore, there will always be a small risk associated with having a blood transfusion.

The risk of getting variant Creutzfeldt-Jakob Disease (vCJD) from a blood transfusion is extremely low. Each year, approximately 2.6 million blood components are transfused in the United Kingdom and there have been just a handful of cases where patients are known to have become infected with vCJD from a blood transfusion. More information on vCJD can be found on the NHS Choices website: www.nhs.uk

Further information on the risks of transfusion can be found at:www.shotuk.org

Will a blood transfusion affect blood spot screening?

A blood transfusion may affect the blood spot screening test, which is offered when your baby is between five and eight days old. If the blood spot sample has not yet been taken, your baby will need it done before they receive a transfusion. In addition, they may require a further sample to be taken following a blood transfusion. More detailed information on blood spot screening is available here:www.nhs.uk

How is blood given?

A blood transfusion is given through a tiny tube directly into a vein. The blood will usually be given from a small bag or by a syringe. The amount of time each transfusion takes will depend on a variety of factors; your baby’s doctor or nurse will be able to tell you more about this. If your baby needs to be given more than one transfusion, it is normally arranged for the blood to come from the same donor.

How will my baby feel during their blood transfusion?

Most babies will not feel anything unusual during their blood transfusion. Your baby will be closely observed before, during and after the blood transfusion; but please inform staff if you have any concerns about your baby during or after the transfusion. Severe reactions to blood are extremely rare. If they do occur, staff are trained to recognise and treat them.

Can I donate my blood for my child?

No. This is a common question but there are good reasons why this is not done. There is an increased risk of some types of serious reactions following blood transfusion from relatives. Unless blood from a close relative is specially treated with X-rays there is a risk that the transfused blood can trick the baby’s immune system and bone marrow, resulting in bone marrow failure. It is better to avoid this risk.

What if I have other worries about blood transfusion?

If you are worried or have any questions, please talk to your baby’s doctor or nurse. Many hospitals have a dedicated Hospital Transfusion Team and they may be able to come and discuss your concerns with you.

Become a blood donor

Nationally we use thousands of units of blood per year in the treatment of children. If you would like to help others by becoming a blood donor, please call 0300 123 23 23 or visit our website: www.blood.co.uk

Additional Information

As a precautionary measure to reduce the risk of transmitting vCJD, people who have received a transfusion of blood or any blood component since 1980 are not currently allowed to donate blood or blood components.

If you are interested in finding out more about blood transfusion and have access to the internet, you may find the following websites useful:

www.nhs.uk

www.nhsbt.nhs.uk

Refusal of a blood transfusion

We want to be sure that we treat every woman in a way which recognises her individual choices or religious beliefs. North Bristol NHS Trust has an active programme to reduce blood loss and reduce the number of blood transfusions given to all women.

Before giving anyone a blood transfusion the risks and benefits of having or not having blood or blood products will be discussed with you. It is up to you to decide if you are willing to accept these risks.

What if I am thinking of becoming pregnant?

You may wish to talk to a doctor before you conceive to think about how you will be looked after in pregnancy and how you can become as fit as possible before becoming pregnant. Your GP can arrange an appointment for you to see a hospital specialist (obstetrician) to discuss this further.

What if I am pregnant?

When you think you are pregnant you should make your GP and midwife aware of your request for no transfusions of blood or blood products. Please do this in writing and ask for it to be included in your maternity hand held notes and medical notes. If you choose not to receive blood, we would strongly recommend that you have your baby on the Central Delivery Suite at Southmead Hospital, rather than at home or in a birth suite. Your midwife or GP will refer you to a consultant antenatal clinic in the early stage of your pregnancy care

You may have an ‘Advance Decision to Refuse Specialist Medical Treatment’ (sometimes known as a ‘no blood form’) which tells us of your wishes about treatments. Let your midwife and obstetrician see this and give a copy to them.

Plan of care for your pregnancy

You will be seen in a consultant antenatal clinic where the following will be covered:

  • Iron and folic acid supplementation throughout your pregnancy
  • Regular blood tests to check your haemoglobin (blood count) is above 12g/dl. If your haemoglobin remains low despite taking supplements and you also have low iron stores you may be given an infusion(s) of ‘liquid iron’ into a vein.
  • As with all women, you will have a detailed scan which will check the position of the afterbirth (placenta) to make sure it is not low-lying
  • Your maternity hand held notes and medical notes will record that you do not want blood and blood products and you will be asked to sign a consent form
  • A copy of your Care Plan ”Management of women who decline blood or blood products in Obstetrics” will be filed in your maternity hand held notes and medical notes
  • You will be asked what treatments and procedures you are willing to accept and these will be recorded on the ”Checklist for Blood /Blood Product Acceptance” in your maternity hand held notes and medical notes
  • If it is felt that you are at particular risk, for instance, if your placenta is low-lying the use of blood salvage techniques will be discussed
  • If your blood group is Rhesus negative we will recommend that you have Anti-D injections during your pregnancy and after delivery if needed (if your baby’s blood group was Rhesus positive). Anti-D is a protein which is obtained from blood plasma. There is no non-blood derived alternative.

What happens in labour and following birth?

When you come into hospital in labour the consultant obstetrician and anaesthetist on call will be notified.

We would recommend that you have an injection to help with the delivery of your placenta (active management of the 3rd stage). If there are any extra risk factors we would suggest that you have an intravenous infusion (‘drip’) or a cannula inserted into a vein so a ‘drip’ can be started or drugs administered quickly if necessary.

You may choose to bring with you and wear a “No Blood” wristband.

If there are any complications your care plan will be followed. At all times, even if an emergency a rises, we will respect your wishes. You can be confident that you will receive the best possible care and treatment during your stay in the maternity unit.

To help us respect your wishes you should:

  • Have informed us in writing and asked that this is kept in your maternity hand held and medical notes
  • Carry an ‘Advance Decision form’ and ‘Care Plan’ with you at all times (in case you are unconscious and we cannot identify you)
  • Before any operation you will be asked to sign an additional consent form. You will be consenting only to treatment you are willing to accept and which you have discussed with your obstetrician.
  • If a consent form for refusal of blood or blood products has not already been signed and is in your notes, you will be asked to sign this when you come into the maternity unit.

If you have any questions or are worried about any aspects of your pregnancy and the birth of your baby, please talk to your midwife or doctor.