My name is Jeannie Callum and I'm a transfusion medicine physician at
Sunnybrook Health Sciences Centre and University Health Network. You've been asked to view this video today
because your physician is recommending transfusion as part of your treatment plan.
This video will cover the process of having a transfusion, the benefits of transfusion, the risks of transfusion and the possible alternatives.
First we are going to review the benefits of transfusion. There are two different kinds of blood products that we commonly use: red blood cells and platelets.
Red blood cells carry oxygen and when your red blood cell level or hemoglobin level drops, either from your cancer
or blood problem, or from the treatment for your condition, you may feel short of breath
when you walk, especially up the stairs. You may feel lightheaded or dizzy
or you may feel your heart racing.
These are symptoms that tell us your body is not getting enough oxygen.
This is usually when your hemoglobin level drops below 65 to 90
but may vary from person to person.
Ask your nurse or physician where your blood level is today.
Red blood cell transfusions will relieve these symptoms and make you feel better.
The second kind of blood product is platelets. Platelets are cells that stop you from bleeding.
If your platelet count drops to a very low level, usually below 10, or you have bleeding, such as nose bleeds,
your physician may recommend platelet transfusion.
Now let me describe the process of having a transfusion.
If you decide to have a blood transfusion, your physician will ask you to sign a consent form for blood transfusion.
By signing this form, you are stating that you understand the benefits, risks and alternatives to blood
and that you've had all your questions answered.
Please make sure you ask all the questions you need to feel comfortable about making this decision.
Next, you will have a blood sample drawn to determine your blood type.
The blood transfusion laboratory will also check to see if you have antibodies to blood.
Patients may develop these antibodies, an immune reaction
after exposure to either the baby's blood during pregnancy,
or to a previous transfusion.
For safety reasons, the blood bank requires your blood group be tested twice on two separate occasions before blood can be issued.
This allows us to be confident about your blood type.
The blood bank will then select a unit for you and label it with your name, hospital file number and your date of birth.
A crossmatch is performed to ensure the blood group of the donor is compatible with you.
The transfusion will take place in the transfusion medicine clinic.
There is nothing special you need to do on the morning of your transfusion.
You can eat normally and take all your regular medications.
Each unit of blood will be run over two to four hours
depending on how fast the blood can be run.
Patients with heart problems must have their blood transfusion run slowly to prevent breathing problems.
As soon as you arrive in the transfusion clinic, the nurses will start an intravenous.
The nurses will take your temperature, heart rate and blood pressure before starting the transfusion.
The nurses will check the blood with either a computer barcode reader,
or with a double check by two nurses to ensure you get the right
unit with your name on it.
Please also review this label before the transfusion is started. The nurse will then start the transfusion.
Other than a slight cool feeling as it begins infusing, you should not feel anything else.
The nurse will run the blood slowly for the first 15 minutes, looking for any reaction.
At 15 minutes, the nurse will recheck your temperature, heart rate and blood pressure.
If there are no changes, the nurse will increase the rate of infusion to complete the transfusion of each unit up to two to four hours,
depending on the rate set by your doctor.
Most patients need one or two units or bags of blood at each visit.
There are two common minor reactions that we see during transfusion that cannot be avoided.
About 1 in 100 patients develop hives, which is a type of itchy rash.
This is a minor allergic reaction that almost always goes away with antihistamines
and then the transfusion can be continued.
At the first sign of itchiness, please let your nurse know so that we can give antihistamines and prevent widespread itchiness.
The second type of reaction is a fever.
It happens in about 1 in 300 transfusions.
The blood cells in the blood products sometimes release flu-like hormones that can cause fever.
These reactions usually go away quickly with medications such as acetaminophen, commonly known as Tylenol.
Please let your nurse if you start feeling feverish or have chills.
You should not feel any other symptoms during your tranfusion.
If you feel anything unusual during or even in the few days after the transfusion
immediately notify your nurse or physician.
Now we're going to review the risks of having blood transfusion.
All blood you're going to receive is going to come from unpaid volunteer blood donors from Canadian Blood Services.
Numerous steps ensure that the risk of having a blood transfusion is as small as possible.
The donor is asked to answer questions about their health and medical history.
Then the donor is taken into a private room with a nurse to ask questions
about high risk behaviour for HIV and hepatitis.
The nurse will also check the donor's temperature, heart rate and blood pressure.
To minimize the risk the risk of bacteria entering the blood product, the donor's arm is thoroughly cleaned.
Also, the first few tablespoons of blood is used for testing
further reducing the risk of bacteria entering the blood bag.
The blood is tested for HIV, hepatitis B and C, syphilis, west nile virus,
a virus that causes leukemia, and a blood parasite common in South America.
Despite this testing, there is still a remote risk of these infections from blood
as shown on this slide. This is because there is a short
period between when the donor becomes infected and when these tests become positive.
For example, this is about ten days for HIV.
The risk of HIV from a blood transfusion is estimated at 1 in 7.8 million donations.
In Canada, we transfuse just under 1 million blood units per year.
This means that once every seven years, someone might get HIV from a blood transfusion in the whole of Canada.
The statistics suggest that you are more likely to be struck by lightning this year than to develop HIV from a blood transfusion.
There are five transfusion complications that you need to know about.
First, some patients that are older or with heart conditions can develop heart failure from a blood transfusion.
Your physician will prescribe a diuretic or water pill and slow the transfusion down, if you have a higher risk of this complication.
Heart failure will cause you to feel short of breath during or after a transfusion.
Second, you need to know about the risk of lung injury from transfusion.
This risk is approximately 1 in 10,000 transfusions.
It happens because of the donor blood - their immune system reacts with your lungs and causes them to flood with water.
The reaction is usually transient and thought to be less common in patients having outpatient transfusions.
Rarely, patients require artificial lung support for a few days after this reaction.
Third: sometimes patients develop a breakdown of the red blood cells due to incompatibility, a type of immune reaction.
Accurate testing by the blood bank has reduced this risk to only 1 in 40,000 transfusions.
Fever, felling unwell and red urine are the first signs of such a reaction.
Let your nurse or physician know immediately, even if this reaction happens after you arrive home.
Fourth, severe allergic reactions such as those seen from peanut allergy are rare but can happen.
They happen shortly after the transfusion is started and your nurse will be watching for this.
Lastly, units of blood can become infected with bacteria despite our prevention strategies.
This risk is 1 in 10,000 from platelets and 1 in a quarter million for red blood cells.
Your nurse will be looking for signs of this in your heart rate, blood pressure and temperature.
This is managed by stopping the transfusion and giving intravenous antibiotics.
Lastly, we're going to discuss the alternatives to blood transfusion.
Unfortunately, despite years and years of research,
scientists have been unable to develop an artificial source of blood cells.
There are two alternative treatments you should discuss with your physician:
iron and erythropoietin, which is a type of blood hormone.
Iron can be safely given both by mouth and intravenous infusion.
Your physician can tell you your iron level and whether you would benefit from iron.
Erythropoietin is commonly used in patients with blood disorders, but its use in patients with cancer is controversial.
Studies suggest this drug may increase
the risk of cancer recurrence and blood clots
We therefore try to avoid its use in patients having cancer treatment where there is a possibility of cure.
When we do use it, we use the smallest possible dose that avoids transfusion.
We don't know which treatment, erythropoietin or transfusion, is the safest option.
We believe that the risks are similar, but have no large
studies directly comparing these two treatments to know for sure.
Ask your doctor if erythropoietin is an option for you.
This therapy is given by weekly injection just under the skin and can be given at home.
This therapy is expensive at a cost of approximately 450 dollars per dose.
It is covered by most drug plans and for patients
over 65 who have advanced cancer who are on chemotherapy.
Now that we've covered the process of having a transfusion, the benefits and risks
of transfusion, and the available alternatives, please be sure to discuss
with your nurse and physician any further questions you may have.
We want to make sure that you have the information you need to make this very important health decision.
If you would like more information about transfusion, please visit the Transfusion Ontario website at www.transfusionontario.org