Some of you have received blood transfusions after surgery, after an accident, or for anemia from other causes. There is no question about it, blood transfusions save lives.
It may surprise you to know that there aren’t solid guidelines as to when we should transfuse someone with red blood cells, in other words there is no set degree of anemia (hemoglobin count) for which everyone should be transfused.
The magic number for most adults is 7 – i.e. transfusion should be considered with a hemoglobin concentration of 7g/dL or less (normal hemoglobin for a woman is 11 or higher and for men about 12 or higher.)
The goal is to find that optimal point that gives you the best outcome, yet avoids exposing you to potential infectious and non-infectious risks. To understand our struggle, here is what you need to know about red blood cell transfusions.
1. 1 in 100 patients will experience fever with transfusion of a unit of blood.
2. 1 in 100 patients will get fluid overload from a unit of blood. This can cause shortness of breath and congestion in the lungs and may require treatment with diuretics.
3. Transfusion related lung injury occurs with 1 in 10,000 blood transfusions.
4. The risk of hepatitis C is 1 in 1,149,000 units of blood transfused.
5. The risk of hepatitis B is higher than with hepatitis C and is 1 in 282,000 transfusions.
6. A life threatening transfusion reaction will occur with 1 in 139,000 transfusions.
7. The risk of HIV from a blood transfusion is 1 in 1,467,000.
8. The risk of fatal hemolysis is 1 in 1,250,000 units of blood transfused.
9. Compare these risks to lightning fatalities in Wyoming which occur in 2 per million persons, in California its 2 per 100 million.
10. The risk of being killed on a single airline flight is 1 per 29.4 million and the risk of homicide from firearms is 4 per 100,000 persons.
This list is not meant to freak anyone out, and in many ways is very reassuring. It’s just good to know that even with tight screening, blood transfusion isn’t perfect.
- Dr. O
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