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RECEIVING A TRANSFUSION INFORMATION FOR PATIENTS AND RELATIVES

RECEIVING A TRANSFUSION INFORMATION FOR PATIENTS AND RELATIVES The purpose of this leaflet is to explain about the functions of the di erent components of blood why a transfusion may be necessary outline the benefits and risks of transfusion and provide you with all the relevant information you require to make an informed decision about receiving a transfusion If you have any questions relating to the information in this leaflet these can be discussed with your doctor or the nurse looking after you or you can also ask to speak with the transfusion specialist Haemovigilance O cer in the hospital 2 This Leaflet Explains PAGE 1 What Is A Blood Transfusion 4 2 The Functions Of The Di erent 5 Blood Components 3 Why You Might Need A Transfusion 6 4 What You Can Do To Reduce The Need 7 For Transfusion 5 What Are The Risks Of Transfusion 8 6 What Steps Are Taken To Ensure 10 The Transfusion Process Is Safe 7 What Infections and Viruses Can Be 11 Transmitted Through Transfusion 8 How Transfusion Is Given And What 12 To Expect During Transfusion 9 What Happens If You Refuse A Transfusion 14 10 Having A Transfusion In 14 The Day Unit Setting 3

1 What is a Blood Transfusion When blood is donated it is separated into di erent components including red blood cells platelets and plasma These are used for treatment of di erent conditions and the purpose of this booklet is to explain the reasons for your transfusion Like all medical treatments a transfusion should only be given when it is really necessary The decision to give a transfusion is made only after careful consideration In making the decision your doctor will balance the risk of you having a transfusion against the risk of not having one If your doctor feels a transfusion is necessary they should explain the risks and benefits and any available alternatives before the transfusion is prescribed They will then obtain your consent to transfusion and document this If this has not been explained to you then ask the doctor or nurse looking after you If it has been necessary to transfuse you as an emergency before you could be asked the reasons for the transfusion and written information can be provided afterwards Irish Standards in relation to blood transfusion require that all sta involved in your transfusion have had specified training in the clinical transfusion process 2 The Functions of the Di erent Blood Components Red cells carry oxygen around our body via the blood The Haemoglobin Hb is the specific part of the red cell that carries the oxygen When the Hb level is low this is called anaemia Anaemia can result in not enough oxygen being transported to vital organs such as our hearts and lungs If this occurs slowly over time it can cause symptoms such as shortness of breath tiredness or appearing pale to develop However if the Hb drops suddenly for example if you are bleeding this may cause you immediate harm and you may need an urgent blood transfusion Platelets are small cells found within blood which are the body s first response to bleeding If you are bleeding platelets will form a plug which helps the blood to clot If your platelets are not working properly or if you do not have enough platelets you may notice that you bruise easily have small red spots on your skin or bleed more easily or for longer from any cuts you receive Platelets are transfused to either prevent or stop bleeding Plasma is the fluid part of the blood in which our red blood cells and platelets are suspended It also contains many di erent clotting factors Clotting factors are proteins which help the blood to clot so a transfusion of plasma increases the level of clotting factors in your blood People can also develop low clotting factors when they have liver damage or infection or even after receiving large volumes of blood 4 5

SOME COMMONLY ASKED QUESTIONS 3 Why Might I Need a Transfusion Bleeding Anaemia Blood Transfusions can save lives Most people can cope with losing a moderate amount of blood without needing transfusion as our bodies can make new red blood cells over the following weeks However if larger amounts of blood are lost a blood transfusion may be the only way of replacing blood rapidly A blood transfusion may be needed to treat severe bleeding for example during or after an operation in childbirth or major accident A blood transfusion can also be used to treat anaemia a lack of red blood cells Bone Marrow not working properly Bone marrow is where our red cells and platelets are made If your bone marrow is not working properly you may need a red cell or platelet transfusion Certain diseases or cancer treatments such as chemotherapy or radiotherapy can reduce body s ability to make new red cells or platelets while you are on treatment Bone marrow can take up to a month to recover post treatment Genetic Conditions Some people have genetic conditions like sickle cell disease which require lifelong blood transfusions 6 4 What Can I Do To Reduce My Need For Transfusion Your symptoms together with laboratory blood test results such as Haemoglobin and platelet counts will show if you need a transfusion Healthcare sta are educated to transfuse you only when necessary They will assess your symptoms and laboratory blood test results to help decide if you need transfusion If you are due to have an operation soon it may help to take iron supplements in the few weeks before your surgery ask your GP or consultant especially if you know that you have had low iron levels in the past If you are on certain drugs such as Warfarin Clopidogrel Plavix Aspirin or some of the newer types of anticoagulants check with your GP or consultant whether or not you should stop these before your operation Stopping these drugs may reduce the amount of bleeding but this decision can only be made by your doctor One unit at a time If you are not bleeding you should receive a single unit of red cells After this you should be reassessed to decide if you need any further units Avoiding Red cell Transfusion Many causes of anaemia are treated by other ways rather than giving a transfusion If you are anaemic treating you with iron replacement therapy or other nutrients might be enough to avoid transfusion Sometimes your own blood can be recycled during an operation such as in orthopaedic surgery This means they use a cell salvage machine This is a machine that captures the blood you loose and returns it immediately to you Ask if this is suitable for you 7

Can I donate my Own Blood You cannot donate blood to be transfused back to yourself in Ireland This is because there is no evidence to show that this is safer European regulations state that taking donations from family or friends known as directed donation is not good practice All Irish blood donors are voluntary and unpaid 5 What are the Risks of Transfusion Transfusion can be lifesaving but like other medical treatments is not completely free of risk One of the main risks from a red blood cell transfusion is receiving blood of the wrong blood group Misidentification The risk of receiving the wrong blood group is two per million units transfused Most of these errors are caused by misidentification of the patient either when the blood sample is taken prior to transfusion to check the blood group or when the transfusion is being given at the bedside To ensure you receive the correct transfusion clinical sta will make careful identification checks They will ask you to confirm your full name and date of birth They will then check the details on your wrist band and on the unit of blood to ensure that you receive the correct transfusion 8 You have a Vital Role in making sure you are Identified Correctly Always check the name date of birth on your hospital ID band is correct If you notice any errors please tell a member of sta immediately When a sta member is taking your blood samples or is about to give you a transfusion make sure they check who you are even if they know you They should always ask you but not prompt you to confirm your full name date of birth They should then check these details against the details on your ID band Please also inform a member of sta if you have ever had a reaction to a blood transfusion in the past or if you have been told you have special transfusion requirements such as requiring CMV negative irradiated blood Antibodies Donated blood will be specially selected to match your own blood for the most important blood groups Some patients can develop an antibody to the transfused blood and will have to have specially matched blood if this occurs If you are aware that you have an antibody or have had a reaction to blood or blood components in the past it is important that you tell your doctor or nurse so that they can inform the hospital transfusion laboratory Having an antibody carries no other problems for your health Transfusion Reactions Most people feel no di erent at all during their transfusion however your nurse will observe and monitor you during your transfusion particularly during the first 15 minutes so that any potential symptoms of reaction are picked up and treated quickly if they do occur It is important to tell your nurse if you feel anyway di erent or unwell during your transfusion Very often symptoms such as mild fever chills can occur these can be easily treated by giving Paracetamol and slowing down the rate so that your transfusion can be safely completed 9

Severe transfusion reaction is rare and even if you do have such a reaction to blood it does not mean that there is any cause for concern If symptoms of reaction do occur your nurse will stop the transfusion and call a doctor to assess you Your symptoms will be treated and the reason for the reaction investigated 6 What Steps Have Been Taken to Ensure The Blood Supply Is Safe The Irish Blood Transfusion Service IBTS have many safeguards in place to protect our national blood supply All donors are voluntary and unpaid as such donors are the safest source of blood Before giving blood donors must answer detailed questions to ensure they are in good health and to rule out risk factors for disease Donors who have any risk factors are not allowed to donate Every unit donated is tested for the following infections which can be transmitted through blood Human Immunodeficiency Virus HIV Types 1 2 Hepatitis C Virus Hepatitis B Virus Hepatitis E Virus Syphilis Human T Lymphotropic Virus HTLV Types 1 2 7 What Infections and Viruses Can Be Transmitted Through Transfusion Viruses A great deal of publicity has been given to the potential risks of getting HIV or Hepatitis from transfusion All blood transfused in Ireland has been tested for these viruses When you consider the risks of transfusion it is important to realise that the risk of infection from blood transfusion is very low Daily activities such as road travel are associated with much greater risks than the risks of being transfused The current estimated risk of viral infection in Ireland are as follows HIV 1 possibility in 9 million units donated Hepatitis C 1 possibility in 12 million units donated Hepatitis B 1 possibility in 5 million units donated These figures are from the Irish Blood Transfusion Service IBTS 10 11

Other Infections The careful collection and storage of blood reduces the risk of bacterial infection in blood which is rare but can be fatal Variant CreutzFeldt Jacob Disease vCJD is a relatively new and fatal disease which is caused by eating BSE contaminated meat more commonly known as mad cow disease It is known that vCJD can be transmitted through blood transfusion although the risks of this are believed to be very low To date there is no test for vCJD but the IBTS have introduced the following precautions to reduce the risks of transmission The removal of white cells from all units of blood The exclusion of donors who have received a blood transfusion in the past Importing virally inactivated plasma from BSE free zones It is important to realise that if you need a transfusion the risks of not having it far exceed the extremely low risk of developing infection from a transfusion Above we have outlined the infectious risks that we are aware of however there is always a risk of transmission of other currently unknown diseases 8 How Is A Transfusion Given First a blood sample is taken from you and sent to the blood transfusion laboratory for testing This pre transfusion testing will determine your blood group and screen your blood for antibodies Once this testing is complete units of blood that are matched to your blood can be issued for you Using a sterile needle and tubing the transfusion is dripped into a vein usually in your arm A bag of blood usually takes between 2 4 hrs to transfuse but it can be given more quickly if required A platelet or Plasma transfusion usually takes 30 minutes to an hour to transfuse 12 13

9 What Happens If I Refuse A Transfusion You have the right to not agree to transfusion after discussing the risks of refusal with your consultant It is important to know that the risks of refusal are greater for certain people including bleeding patients older patients and patients with cardiovascular disease heart or lung conditions The hospital has a policy on refusal of transfusion which will be used to guide hospital sta to safely manage any patient not agreeing to transfusion as part of their treatment 10 Having A Transfusion In The Day Unit Setting Sometimes patients will receive their transfusion in a day unit setting It is important that you feel well before you leave the hospital following your transfusion The nurse in the day unit will give you the phone number and contact details of the person s in Beacon Hospital to contact if you develop any symptoms of reaction or feel unwell at home following transfusion Other Information After you have been transfused you will no longer be eligible to donate blood in Ireland This is a precaution against the transmission of vCJD In Ireland we are required by law to keep all transfusion records for 30 years If you are interested in finding out more about transfusion and have access to the Internet you can log onto the Irish Blood Transfusion Service IBTS website www giveblood ie If you have any further questions in relation to your transfusion or would like to discuss any of the information contained within this leaflet further you can talk to your doctor or nurse Alternately you can ask to speak with the Haemovigilance O cer The section below can be used for further notes contact details or to write down any questions you may have for your doctor or nurse 14 15

Document Number LP BB 085 Issue date Oct 2022 Beacon Hospital Sandyford Dublin 18 D18 AK68 Tel 01 293 6600 www beaconhospital ie