Blood Component Transfusions

Blood component transfusions, also called blood transfusions, can improve a patient's condition or even save his or her life. The number of patients who become seriously ill or die from a blood component is very small when compared to the benefits that blood components can provide.

You should discuss with your physician the specific need or reason for the blood component you or your child is about to receive.

Blood components are often used to replace red blood cells or other elements of the blood that are missing or at low levels due to an injury or illness.

Blood components are obtained from blood collected from volunteer blood donors. Blood donation programs exist to allow blood to be donated by a patient for themselves, by anonymous donors or, in some situations, by someone specified by the recipient.

Blood may be processed into any of these various blood components:

Whole Blood  

Whole blood contains red blood cells and plasma. Whole blood is often used for open-heart surgery and may also be used for exchange transfusions (complete replacement of a baby's blood) in newborns with hemolytic disease of the newborn. This product is otherwise not commonly used.

Packed Red Blood Cells  

Red blood cells carry oxygen to the tissues. Packed red blood cells have had most of the plasma removed from the whole blood. Packed cells are usually given into a vein over two to four hours to replace the red cells lost through bleeding, hemolysis (destruction of the red blood cells), or decreased production of red cells by the bone marrow. The decreased production of cells may be due to bone marrow failure, cancer involving the marrow, or the effect of chemotherapy drugs used to treat a cancer.

Fresh Frozen Plasma  

Fresh frozen plasma is plasma which was frozen and stored shortly after it was obtained from the blood donor. Fresh frozen plasma contains many clotting factors and is often used alone or with cryoprecipitate to replace the low levels of clotting factors. It is usually given into a vein over one to two hours.

Platelets  

Platelets are the cell fragments which prevent or stop bleeding or bruising by physically plugging the hole in the blood vessel. Platelets are usually given into a vein over a few minutes to an hour. If a patient's bone marrow is not producing platelets, then platelet transfusions are usually needed once or twice a week, or even more often. Platelets may also be given when a patient's platelets are not functioning properly due to medicines, illness or mechanical damage (such as from an artificial heart valve).

Cryoprecipitate  

Cryoprecipitate is the part of the blood which contains only certain clotting factors such as factor VIII (deficient in hemophilia A), von Willebrand factor, and fibrinogen. Currently, cryoprecipitate is usually given only as a source of fibrinogen (necessary for forming a clot). Some patients with certain types of hemophilia or patients who lack fibrinogen may receive cryoprecipitate to treat their clotting defect. Also, severely ill patients may develop an abnormal clotting condition known as DIC (disseminated intravascular coagulation), which can cause a decrease in the body's clotting factors and result in severe bleeding. Cryoprecipitate along with fresh frozen plasma (see above) may be given to help replace the clotting factors that are low. Cryoprecipitate is usually given over just a few minutes to an hour into a vein.

Granulocytes  

Granulocytes, also called neutrophils, are the cells which help fight off bacterial or fungal infections. Granulocytes are very occasionally given to help fight off severe infections in patients who have very low numbers of granulocytes in the blood and have not responded to medications. Most often granulocytes are given daily for five days or until the patient's granulocyte count returns to a level which allows the patient to fight the infection on his or her own. Granulocytes are usually infused into a vein over one to two hours.

Sometimes there are adverse reactions that occur with the use of a blood component. Most of these reactions are not common and can usually be easily managed. If an adverse reaction occurs, alternative methods to solve the problem may be used.

  • Immune mediated adverse reactions can occur if a patient's immune system reacts to the blood component or if the immune cells in the blood component react to the patient's cells or fluids. These reactions are not common. They may include allergic reactions, an anaphylactic reaction, the development of red blood cell or platelet antibodies which shorten the lifespan of these cells in the bloodstream, transfusion-related damage to the lung tissue (TRALI), a delayed destruction of red blood cells, and graft versus host disease (GVHD).
  • There are several possible non-immune mediated adverse reactions. Most of them are rare. These may include bleeding problems, fluid overload, reaction from extra potassium in the blood component, tingling of the hands and lips caused by lowered blood calcium level, and an overload of iron in the body tissues which can occur in patients who receive more than 100 units of red blood cell transfusions.
  • An infection could occur from the use of a blood component that contains bacteria, a virus (for example, cytomegalovirus, hepatitis B and C, or HIV) or a parasite. Infections from transfusions are rare since screening blood donors and testing and filtering blood has made the blood supply in the United States the safest that it has ever been. The risk of contracting hepatitis B can be further reduced with a vaccine.

Learn more about these risks by speaking with your healthcare team.

Symptoms to watch for include:

  • Fever over 100.6°F (38°C) orally
  • Blood pressure changes
  • Chills, headache, nausea, vomiting, diarrhea or back pain
  • Dark-colored urine, hives, itching, wheezing or shortness of breath or difficulty breathing
  • Swelling of feet or ankles, or a cough that was not present before the transfusion
  • Delayed reactions -- in rare cases, a delayed reaction can occur three to 10 days following a transfusion of red blood cells. Call your child's doctor if your child develops a fever or becomes pale or jaundiced (yellow color in skin and whites of eyes) three to 10 days after a blood transfusion.

If your child should develop symptoms after receiving a blood product, call your nurse or doctor right away.

There are other possible choices in some situations. Your healthcare team can identify which ones may be used, depending on your child's condition. These alternatives include:

  • Drugs are available which can stimulate the bone marrow to make more red blood cells (erythropoietin), white blood cells (granulocyte-colony stimulating factor), and platelets (interleukin-11). Newer agents are being developed.
  • Bleeding problems can be treated by giving specific clotting factors such as Coagulation Factor VIII or IX concentrates, or by giving drugs which decrease the risk of bleeding in the mouth and throat (Amicar) or increase the level of certain coagulation factors (DDAVP). If the bleeding is caused by too much heparin in the body, this can be reversed by protamine sulfate.
  • Some patients who have surgery can have their own blood stored before the surgery. After the surgery, they get their own blood back (an autologous unit). Other patients may have their blood which is lost during surgery given back to them (intraoperative salvage procedure).
  • You may also ask a specific donor to give blood for the transfusion, if the donor is compatible and the blood is free of infectious agents. Experience has shown that these directed donor units are not any safer than blood from a regular volunteer blood donor. Some patients can tolerate a low hemoglobin level for a few days after surgery and build back their own blood supply by taking extra iron. Some patients, for religious reasons, specifically try to avoid blood product transfusions. The above alternatives are available to them. In the future, a blood substitute may become an option for such patients.

For more information about blood components, speak with your child's doctor. Additional information is also available at the following websites:


Last Updated 12/2013