Transfusion therapy

ALSO KNOWN AS: Blood transfusion, red cell transfusion, platelet transfusion, plasma transfusion, cryoprecipitate transfusion, granulocyte transfusion

DEFINITION: Transfusion therapy is the infusion of blood components.

Cancers treated: All

Why performed: Cancer patients may need a transfusion of blood components because of the disease itself or as a result of cancer treatments. Some cancers, such as those of the digestive system, may cause loss of blood through internal bleeding. Patients with cancers affecting the production or storage of blood cells may need transfusion if blood counts become too low. Treatments such as chemotherapy and radiation may destroy enough cells that patients need transfusion. Patients having surgery for cancer may need blood to replace blood loss during the procedure.

Patient preparation: The physician admits the patient to an inpatient or outpatient facility. The physician discusses the benefits and risks of transfusion with the patient or legal guardian and asks them to sign an informed consent for transfusion. Patients experiencing previous allergic reactions to blood components are given a pretransfusion medication such as diphendydramine (Benedryl).

Steps of the procedure: A phlebotomist collects a blood sample. In some facilities, a special transfusion armband is placed on the patient’s arm at the time the blood sample is collected. Other facilities use the standard hospital patient armband for identification. The sample is sent to transfusion services.

Transfusion services staff test the sample to determine the patient’s blood type. An screening is also done to detect any unusual antibodies or proteins that may cause adverse reactions if the corresponding antigen is present in the donor cells. These antibodies may be naturally occurring, formed from exposure to a blood cell antigen during previous blood transfusions, or, in females, during childbirth. If unusual antibodies are present, then donor units that lack the corresponding antigen are used for transfusion. Transfusion services staff select appropriate components from storage. If the component is red cells, then a crossmatch is performed to ensure compatibility between the patient’s serum and the donor red cells. Platelets, fresh frozen plasma, or cryoprecipitate do not need to be crossmatched. The selected components are tagged with the patient’s name and identification number, the component unit number, the blood type of the patient and the donor, the results of antibody screening, and any special needs.

Special needs that the physician may order are leukoreduction and/or of cellular components (red cells and platelets). Leukoreduction is the removal of white cells, which decreases exposure to leukocyte antigens and cytomegalovirus (CMV). Irradiation is done to prevent graft-versus-host disease.

A nurse inserts an intravenous (IV) line into the patient’s arm. Two nurses verify the identification of the patient, and that information on the component tag matches the patient and donor information. Before starting the transfusion, the nurse checks and records the patient’s temperature, pulse, and blood pressure. During the first fifteen minutes of the transfusion, the nurse stays at the bedside and observes the patient for any signs of adverse reaction. At the end of fifteen minutes, the nurse again checks and records pulse, temperature, and blood pressure. Transfusion of blood components takes as little as fifteen minutes to as long as four hours, depending on the component and the rate of transfusion that the physician orders. At the end of the transfusion, the nurse again checks and records the pulse, temperature, and blood pressure, comparing them with the beginning rates. Changes greater than established standards at any time or adverse patient symptoms may result in stopping the transfusion. The physician reviews the information and may order a reaction workup.

In the event of a reaction workup, any remaining component and the transfusion tubing are sent to transfusion services. A phlebotomist collects a new blood sample and sends it to transfusion services. Nursing staff and transfusion services staff review all patient identification, paperwork, and donor information. Repeat testing is performed on pretransfusion and posttransfusion blood samples and the donor sample. Additional tests, such as a culture for bacteria or other blood and chemistry tests, may be done. A pathologist reviews the results of the transfusion reaction workup and determines the cause. The patient will not be transfused with additional components until the workup is completed.

After the procedure: The IV line is removed. The nurse advises the patient about signs and symptoms to watch for and report. Blood samples may be collected to test for hemoglobin, platelet count, or clotting factors. If transfusion is done on an outpatient basis, then the patient may be discharged shortly after completion of the transfusion.

In the twenty-first century, transfusion therapy has seen myriad advances. Improved safety through leucodepletion and viral inactivation has reduced the risk of disease spread and improved donor screening and virus-detecting assays. Treatment through transfusion has become more personalized to the patient and targeted to their medical condition. The amount of donor blood a patient needs has also been reduced due to new technologies like HemoSep, which can recover lost blood during surgery and reduce the amount required for transfusion. Other advances include stem cell storage, molecular red blood cell antigen typing, and the genetic characterization of blood group antigens. Further, the proliferation of electronic medical records has increased the safety of transfusion therapy. 

Risks: The risks of transfusion are allergic reactions, transmission of viruses or infectious diseases, fever iron overload, lung injury, acute hemolytic reaction, delayed hemolytic reaction, and graft-versus-host disease.

Results: Red cells are given to replace blood loss or correct anemia. Platelet transfusions are given to replace platelets to prevent bleeding. Plasma and cryoprecipitate are given to correct coagulation factors. Rarely, granulocytes are given to increase the white blood cell count.

Bibliography

“Advances in Transfusion Medicine.” American Society of Hematology, 5 Dec. 2008, www.hematology.org/about/history/50-years/transfusion-medicine-advances. Accessed 19 June 2024.

Halabi, Wissam J., et al. "Blood Transfusion in Colorectal Cancer Surgery: Incidence, Outcomes, and Predictive Factors; An American College of Surgeons National Surgical Quality Improvement Program Analysis." American Journal of Surgery, vol. 206.6, 2013, pp. 1024–33.

Hillyer, Christopher D. "Blood Banking and Transfusion Medicine – the Field, the Discipline and the Industry." Transfusion Medicine and Hemostasis, 2009, pp. 1-8, doi.org/10.1016/B978-0-12-374432-6.00001-4. Accessed 19 June 2024.

Klein, Harvey G., and David J. Anstee. Mollison’s Blood Transfusion in Clinical Medicine. 12th ed., Hoboken: Wiley, 2014.

Niederhuber, John E., et al. Abeloff's Clinical Oncology. 5th ed., Philadelphia: Saunders-Elsevier, 2014.

Shaz, Beth H., et al., eds. Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects. London: Elsevier, 2013.

Stanworth, Simon J., et al. "A No-Prophylaxis Platelet-Transfusion Strategy for Hematologic Cancers." New England Journal of Medicine, vol. 368.19, 2013, pp. 1771–80.