Doc Talk: Blood transfusions are fewer and safer than ever

02/25/2014 6:03 AM

08/08/2014 10:22 AM

There are several common concerns regarding the safety and necessity of blood transfusions. The medical community has taken these concerns quite seriously and developed many strategies that address these issues and may reassure the public regarding transfusion safety.

Transfusions are sometimes necessary when blood is lost during surgery or in patients who have low blood counts because of problems such as anemia, internal bleeding, hemophilia, burns, liver failure or severe infections. Interestingly, only particular parts or components of blood are needed by individual patients. Rarely is whole blood given to a patient. After blood is donated, it is separated into its various components: plasma, platelets and red blood cells. When a transfusion is needed, only the appropriate component is given.

A common concern about donated blood is the possibility of being infected with HIV, hepatitis or other diseases. All blood obtained by the American Red Cross is screened and tested in several different ways to eliminate tainted blood. In Wichita, all blood used by hospitals has been certified by the Red Cross. While no process can provide 100 percent protection against any infection when biologic tissue is used, the infection rate associated with transfusion is on the order of one in several hundred thousand to one in a million.

Very rarely, the body of an individual who receives a transfusion can reject the blood component in a way that affects the lungs, kidneys and other organs. Inflammation can also be triggered by a transfusion. While serious, these reactions are extremely uncommon and the risk of such a serious reaction is routinely weighed versus the benefit of transfusion. If risk outweighs benefit, no transfusion is given.

Many people believe that surgery always requires a transfusion, but, in fact, transfusions are rarely necessary. The expertise of today’s surgeons and the use of current technology keep blood loss at a minimum. Less than 10 percent of surgeries require any type of transfusion. In some cases, the patient’s own blood can be recycled during surgery, further lessening the frequency with which operative patients are transfused.

Research has been done to determine how much blood a patient must have in the body. The amount is lower than previously expected, thus reducing the use of transfusion. We have also learned the body is very good at creating its own blood cells, quickly replacing those that are lost.

Another possible way to reduce the need for transfusion is chemical prophylaxis. This involves giving the patient a medication before surgery that will decrease blood loss. The medication changes the way blood reacts to hemorrhage and increases the ability of the blood to clot. This preventive technique is usually appropriate only for high-risk patients, newborns and patients who refuse transfusion for personal or religious reasons.

At Wesley, all transfusion orders are reviewed by several professionals, including additional physicians and blood bank technologists, to ensure that the transfusion is absolutely necessary and appropriate. As a result, each patient can rest assured that every precaution has been taken to ensure patient safety.

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