Things to know if your child needs blood transfusion

• Severe anaemia
• Severe injuries such as those from a car crash
• Severe burns
• Cancer
• Undergone stem cell or organ transplant
• Those who have had a heart surgery
• Those with haemoglobin disorders (eg, sickle cell disease, thalassemia)
• Those whose platelets do not work well
• Those whose bone marrow does not work well

What do different parts of the blood do?

Red blood cells (RBC) carry oxygen to the tissues in the body so that they work well and stay alive. If there has been a lot of bleeding, a patient may need a red blood cell transfusion. This helps get oxygen to tissues and prevents more damage. Platelets are cells that help prevent and stop bleeding. Plasma is the yellow liquid that surrounds the red blood cells and platelets. Plasma is used most often to help blood clot. It may be used with platelets to prevent or stop bleeding.

Where does the donated blood come from?

Blood is collected from donors who can either be voluntary or replacement donors. Before taking blood from a donor, the process of donor screening is carried out which includes detailed medical history, physical examination and checking the vitals. After collection, sample from each donated unit is tested for infections as per government guidelines. Each blood unit is divided into separate parts or units. If your child needs a transfusion, he or she will be given just the part that is needed.

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Are there risks to having a blood transfusion?

Blood is a drug and like all drugs it may have some side effects or risks in few patients.

Allergic reactions: These are the most common type of reactions and include rashes and hives. They are usually mild and easily treated. Severe allergic reactions are rare.

Fever reactions: A fever usually means a patient’s body is reacting to white blood cells or plasma proteins from the donor’s blood. Nowadays many blood banks are using filters for removing white cells from the collected blood which is called leucodepletion. It has helped in preventing the risk of febrile reactions to almost zero.

Infectious disease transmission: Every effort is made to ensure that the blood your child receives is safe. Donors are interviewed to make sure they are healthy, and then every unit of blood is tested. But even with this system, there is still a small risk of catching a disease from donated blood. It is possible for a donor to have a virus and not seem sick and the tests are not able to pick it up because of very low numbers.

Are there chances my child will get an infectious disease?

Because blood donors are screened and their blood is tested, blood transfusions are very safe. The risks of getting diseases such as HIV, hepatitis B and hepatitis C are very small. Introduction of latest methodologies of testing blood by NAT (Nucleic Acid Test) has helped in picking up infections in the blood very early thus reducing the risk of transmission to the minimum. Although blood can never be
100 per cent safe, the risk of infection from transfusion is very low.

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What if I decide to not allow my child to have a transfusion?

Doctors decide to give blood transfusion only if it is required to manage the clinical problem. There are many conditions where it needs immediate replenishment. Accidents or surgery can cause heavy or uncontrollable bleeding. A transfusion can save a life or prevent serious complications. If blood is not replaced, the patient may go into shock, lack oxygen or even die. If platelet counts are very low, the patient will bleed too much and bruise. Without a platelet transfusion, there can be bleeding inside the body. There can also be massive bleeding, especially in the head. So the decision of transfusion can be discussed with the doctor. Your doctor will explain why a transfusion is needed, along with the risks and benefits, as long as there is enough time. This is called the informed process.

Is informed consent necessary?

Yes, in situations that are not life-threatening, patients or their parents or guardians need to understand why a transfusion is recommended, and the benefits and risks. By providing you with this information handout and the chance to discuss it with your doctor, you should be able to give your informed consent for this procedure to go ahead. Sometimes an urgent transfusion may be needed in a life-threatening situation. In these cases, it will not be possible to get informed consent in advance.

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How is a transfusion done?

If your child is old enough to understand, try to explain the procedure by going over what will happen.

– Before the transfusion begins, a small amount of your child’s blood will be tested to identify its type and to make sure it matches the donor. This is done by inserting a needle into a vein in your child’s arm (this should only sting for a few seconds) and withdrawing the blood into a test tube to be used by the laboratory.

– Next, a sterile, single-use plastic catheter will be placed into a vein in your child’s arm and taped in place.

– The nurse attending to your child will make sure that the blood that is used is the correct blood for your child.

– A bag holding the blood product will then be hung on a pole next to your child’s bed.

– Last step involves a plastic tube which will be attached from the bag to the tube or needle in your child’s arm. The transfusion starts when the contents of the bag start to flow.

Duration of transfusion depends on the blood part used, it is maximum for red cells and minimum for platelets.

(The writer is the HOD, Dept of Transfusion Medicine, Fortis Memorial Research Institute, Gurugram)