Blood transfusions are usually fairly simple procedures that rarely lead to issues. However, mistakes can be made and it could be that the patient (or donor) is harmed more than healed.
Administration of a blood transfusions
A transfusion involves taking blood from a healthy person, free of viruses and illness, and giving it to someone with the same blood type. Blood transfusions have only been possible since the early 20th Century. These were direct procedures where both patient and donor would be present and the first indirect transfusion was in 1916.
This is the type we use today, where blood is donated by ordinary people and stored in blood banks. Blood isn’t stored as we know it, but separated into red blood cells, white blood cells, platelets and plasma which all have separate functions:
- Red Blood Cells – These transport oxygen cells round the body and can be used to treat anaemia
- White Blood Cells – Fight infection
- Platelets – Stop the bleeding when a person is injured, prevent excessive bleeding for people with weakened immune systems such as chemotherapy patients
- Plasma – Contains vital nutrients and proteins for the body and makes up the majority of blood.
Blood is fed into the body through a plastic tube, usually inserted into a vein in the arm. The process can take between 30 minutes and 4 hours depending on the amount of blood and the patients.
The body has about five litres of blood (8 or 9 pints) For small losses of blood (less than 1.5 litres/2.5 pints), a blood transfusion isn’t necessary and it can be replaced with a salt solution which the body replaces over a few weeks.
Reasons for transfusion
A transfusion may be necessary for losses greater than 1.5 litres and for certain conditions.
For red blood cells:
- Anaemia – This is when the body isn’t getting enough oxygen due to a lack of red blood cells. This can result in heavy blood loss during pregnancy, injury or operation
- Red blood cells being destroyed – This can be caused by factors such as lead poisoning, certain medications, infections like malaria, toxins like alcohol and the immune system mistakenly attacking healthy cells.
For white blood cells:
Granulocytes (a type of white blood cell) are used when a severe infection isn’t responding to antibiotics following chemotherapy or a bone marrow transplant. This is quite rare however.
For platelets:
A lack of platelet cells is called thrombocytopenia which has a risk of causing heavy bleeding even after a very small cut or graze. Thrombocytopenia can be caused by:
- Chemotherapy or bone marrow transplants, which can reduce platelet production
- Chronic liver disease or cirrhosis
- Certain cancers such as leukaemia or lymphoma
- Severe infection or sepsis
For plasma:
Plasma may be needed for severe bleeding following surgery, trauma or childbirth or with conditions that affect the clotting proteins, such as liver disease.
For surgery:
Surgery is usually carried out in a way that reduces blood loss as much as possible and, with the use of keyhole surgery, it is becoming far more common that very little blood will be lost at all. Despite this, there are still operations that cause a heavy amount of blood loss. To account for this, there is a procedure called intra-operative cell salvage. This collects blood that you are losing during surgery and returns it directly back to you.
Errors:
Complications are uncommon with blood transfusions but there is always a risk. It is important to know what has gone wrong in order to take out a claim. Doctors should employ rigorous tests during the transfusion procedure to ensure the correct blood type and health of the blood.
Wrong blood type
Blood is usually tested immediately before a transfusion takes place and it is labelled and categorised during storage so receiving the wrong blood type is rare. If you are given incompatible blood however, it can be fatal. Whenever the wrong blood type is given, this should be considered negligence.
There are four blood types in the ABO system:
- A – has an A antigen and anti-B antibodies
- B – has a B antigen and anti-A antibodies
- AB – has both A and B antigens and no antibodies
- O – has no antigens and anti-A and anti-B bodies
In terms of blood transfusions, this means that:
- A can donate to other types A and AB
- B can donate to other types B and AB
- AB can donate to type AB. It is a universal recipient as it can receive from all others
- O can donate to all others, making it a universal donor.
Infected blood
Blood may be infected when it is donated. It is therefore tested for any harmful diseases such as HIV and Hepatitis. It is rare for infected blood to be transfused but screenings can never be 100% accurate and an transfusion may do more harm than good. There hasn’t been a recorded of someone getting a virus from a blood transfusion since 2005.
Injection done incorrectly
The actual transplant process can also be responsible for a transmitted disease. The arm needs to be cleaned thoroughly to ensure strict hygiene is followed. Contamination is a particular worry for platelet donation as it needs to be kept at room temperature, in which bacteria can develop. Contaminated blood can cause blood poisoning (sepsis) which needs to be treated with with antibiotics. This is more common than viral infections but is still very rare didn’t happen at all in the UK in 2011, according to the NHS.
