Paging Dr. Frischer: Blood transfusions

Joe, my dear friend from back in my medical school days, was a hemophiliac. He was frequently a recipient of blood transfusions. Many of us know someone who has needed a blood transfusion. Perhaps they had a disease, like Joe, or were in an accident, or became dangerously anemic. Perhaps they had the luxury to choose whether or not to have a blood transfusion, or perhaps they faced an emergency life or death situation requiring an immediate transfusion. What are the benefits and risks?

In 1628, a British physician discovered that blood circulates throughout the body. The first successful blood transfusion occurred in England in 1665 when one dog received the blood from another.

Finally in 1818, a British obstetrician performed the first successful transfusion of human blood to a patient, to treat postpartum hemorrhage.

A patient may receive a blood transfusion when they have lost blood from a trauma, have had surgery with blood loss, lost blood due to an ulcer, or has a disease that causes a shortage of red blood cells. An *autologous* red blood cell transfusion is when a donor’s own blood is used for them at a later date, usually before a planned surgery.

A blood transfusion can save a life. It replenishes the body’s red blood cells, which reduces the symptoms of anemia, such as light-headedness, fatigue, weakness, and shortness of breath; and in the case of heart patients, even angina or a heart attack. New guidelines recommend that red blood cell transfusions be considered when the hemoglobin level drops to about seven or eight, depending on the age and general health of a patient, and depending on whether there is active bleeding.

If it is not an emergency, the blood will be typed and crossed in order to make a proper match and avoid possible serious complications. In an emergency where time is of the essence, a patient will receive the universal donor blood type, O Negative. Even O Negative blood can lead to serious reactions, but is the best for an emergency.

However, blood transfusions are not completely without risk:

■ Incompatible blood can possibly cause an anaphylactic reaction or hemolytic anemia. Serious safeguards are in place to prevent this, such as type and cross procedures and multiple staff verification of bags. Medication can be given before a transfusion to reduce risk.

■ It’s possible for pathogens to be introduced into the blood stream, leading to infections. Fortunately, this risk has diminished dramatically over time – for example, the Mayo Clinic lists the odds of developing HIV at around one in every two million transfusions (less likely than being killed by lightning); the risk of hepatitis C at approximately one in 1.5 million transfusions, and the risk of getting hepatitis B at about one in 300,000 transfusions.

■ Bacterial infections are possible but rare.

Jehovah’s Witnesses may oppose blood transfusions on religious grounds. Refusing the possibility of a transfusion may lead to the refusal of a surgeon to conduct a surgery. Today, Jehovah’s Witnesses have a Hospital Liaison Committee to address legal or moral conflicts.

My friend and classmate Joe’s story ended tragically. Our medical school was in San Francisco, and the time was the early 1980’s. AIDS was just being identified, and he became one of its earliest victims. Had he received those blood products today, they would have been effectively tested for the AIDS virus, and even with hemophilia, he could possibly still be with us today.

Blood transfusions are an extremely valuable, life-saving, and safe treatment. The Red Cross provides about 40% of the blood used for transfusions, and I urge everyone to donate blood.