Blood Transfusion And Donation

Every year, nearly 5 million people in the United States receive life-saving blood transfusions. During a transfusion, you receive whole blood or parts of blood such as

Red blood cells - cells that carry oxygen to and from tissues and organs
Platelets - cells can be used to control bleeding
Plasma - liquid part of the blood that helps blood clot

Some people worry about getting a sick from giving or receiving blood. It is possible, but is very rare. The Food and Drug Administration and other organizations that collect blood make sure that blood is safe. Every single donation is tested for HIV/AIDS, Hepatitis C, syphilis and several other diseases that can be transmitted through blood. Some people who know they may need blood during surgery donate their own ahead of time. That is the safest type of transfusion.

What is a blood transfusion?

A blood transfusion is the delivery of whole blood or blood components to replace blood lost through trauma, surgery or disease. About one of every three patients hospitalized at The Cleveland Clinic will receive a blood transfusion during his or her stay. More than 10,000 Cleveland Clinic patients receive a total of about 140,000 units of blood annually. Experience has shown that transfusion is a very safe procedure.

The possibility of a blood transfusion concerns some patients who worry about contracting AIDS or another infectious disease from the blood. If you require a transfusion during your hospitalization, be assured that the entire transfusion process will be expertly performed to protect your safety and health.

Components of blood products

Donated whole blood is typically divided into four different components. You may receive one or all of these different components during your hospital stay:

Red blood cells - the primary carrier of oxygen
Platelets - substances that stop or prevent bleeding
Plasma - replaces blood volume and clotting factors
Clotting factors - substances in the blood that help it thicken (clot)

What are the benefits of blood transfusions?

Red blood cells are usually transfused to a patient to prevent anemia. Anemia is a deficiency of hemoglobin, the primary carrier of oxygen in red blood cells. A substantial loss of hemoglobin in the body can cause injury to vital organs such as the brain and heart. Platelets, plasma and clotting factors are transfused to prevent bleeding. If a patient lacks platelets or clotting factors, profuse (severe) bleeding could occur during surgery, causing a loss of red blood cells (which could result in anemia).

How safe is the blood supply?

Cleveland blood donors have one of the lowest rates in the country of diseases that can be transmitted through blood. In addition, about 80 percent of the blood comes from people who have donated blood in the past. This is important because these people have established a record of safety with us. Every unit of blood used for transfusion at The Cleveland Clinic has been donated by a healthy individual, and each unit has passed eleven different tests for infectious diseases, such as hepatitis (a viral infection of the liver) and AIDS, which attacks the immune system. Donated blood that tests positive for an infectious disease is discarded, and the donor is never permitted to donate blood again.

Despite the best efforts of modern technology, however, there remains a brief period of time during which a healthy but potentially infectious donor may test negative. This is called the window period. Currently, screening tests used by The Cleveland Clinic and other institutions will detect an infection after a window period of several days. The risk of receiving an infection such as HIV (the virus that causes AIDS) through a transfusion is much less that 1 in 1,000,000. In other words, fewer than one in a million transfusions will transmit the HIV virus from a donor to a recipient; less than the risk of being struck by lightning (1 in 600,000 per year). Every unit of blood is carefully tested in the laboratory for compatibility with the patient's own blood before it is approved for use. The label on every unit is checked and double-checked before it is given to the patient.

Where does the blood come from?

Most of the blood used at The Cleveland Clinic comes from the American Red Cross. The donors are volunteers who care enough about some else's medical needs to give a pint of their own blood. Every donor is screened in detail before each donation. Donors are asked questions about their medical history and their lifestyle (sexual history) before blood is collected. This information is used to identify people who might be at high risk for a disease that could be transmitted (spread) through their donated blood.

Should I provide my own donors?

Providing your own blood donor is not advisable for most people. Patients who want to choose their own donors (called directed donors) usually believe it will make blood transfusion safer. It will not. Often, the friends or relatives a patient chooses are first-time donors. Unlike the majority of Red Cross donors, their blood has no proven "track record" of safety. Most people who learn the facts about the safety of blood transfusion choose to let their physician select the blood that will be used. Such selections are always based on the best scientific information available. Directed donors must meet the same strict standards that community blood donors meet. Blood from directed donors must pass tests for hepatitis, AIDS and syphilis, as well as other blood-borne viruses. Each unit must be shown to match the intended recipient's blood type before it will be issued. Processing these tests can take three full working days after the pint is drawn, so arrangements should be made well in advance to avoid unnecessary delays. Any directed units remaining after the intended patient is discharged are released for general use.

What are the costs of blood transfusions?

The costs for a normal blood transfusion include the fees for the collection and storage of the blood unit plus fees for the compatibility test. Blood from directed donors are more expensive because of fees from processing costs. Blood collected from donors who are out of town may include additional shipping fees. Most insurance companies cover all or part of the cost of community and autologous donations. Check with your insurance company if this is a concern to you. For more information on the costs of transfusions, you also may call Cleveland Clinic Patient Financial Services at (216) 445-6249 or 1-800-223-2273 ext. 56249.

How much blood is required for surgery?

Your surgeon can give you an estimate of how much blood your operation might require. Your personal medical history, your blood count before surgery and your estimated blood loss during surgery will all be factors in determining your possible blood needs during surgery. For most types of planned surgery, patients lose so little blood that they don't need blood transfusions. In other cases, the doctor may be able to save some of the blood lost during an operation and give it back to the patient. If a transfusion is required, it may include both blood and blood components. Blood components include:

Platelets - substances that stop or prevent bleeding
Plasma - replaces blood volume and clotting factors
Cryoprecipitate - a concentrate of clotting factors

The need for blood components usually is determined in the operating room.

Are there any side effects of blood transfusions?

Adverse reactions from transfusions happen very rarely; ninety-nine percent of patients experience no side effects. For the one percent who do experience a reaction, the most common ones are hives, rashes, itching or chills. Pain in the chest or back and shortness of breath are rare reactions. Any discomfort you experience after a transfusion will be treated promptly.

Can I donate my own blood for use in surgery?

Yes. When your own blood is donated or collected, it is called an autologous blood donation or collection. Autologous blood is the safest blood available for transfusion, since there is no risk of disease transmission. Autologous blood substantially reduces the risk of side effects from a transfusion. There are four ways autologous donation or collection can be performed and it is up to your surgeon to decide which, if any of them, is appropriate for your operation.

Intraoperative blood collection (also called intraoperative salvage or peri-operative blood collection): a team from The Cleveland Clinic Blood Bank collects the blood lost during surgery and processes it. The red blood cells are then re-infused during or immediately after the surgery.
Preoperative donation: you donate your own blood once a week for about one to three weeks prior to surgery, with the last donation one week before the surgery is scheduled. The blood is separated and the blood components that you need are re-infused at the time of surgery. The doctor must schedule the blood drawings. Iron supplements may be added to your regular diet about 10 days before the scheduled blood collection to increase the number of red blood cells in your body. Preoperative donation is not the most ideal method of blood collection, since there is a high risk of anemia (low red blood cells in the blood) and additional blood products from a donor may still be needed during surgery. In addition, nearly 50% of the blood donated with this method needs to be discarded because it is not used in time for the surgery (since many times, surgeries need to be rescheduled for a variety of reasons).
Immediate preoperative hemodilution: you donate your own blood immediately before the surgery. This procedure is used to decrease the loss of red blood cells during surgery. Immediately after blood is collected, you receive fluids to compensate for the amount of blood removed. Since the number of red blood cells in the person's blood stream has been diluted, fewer red blood cells will be lost from bleeding during the operation. After surgery, the patient's own blood is re-infused.
Postoperative blood collection: blood lost from the surgical site right after surgery is collected after the operation is complete and the surgical site is closed. This blood is then re-infused. Some of these procedures can be used alone or in combination. Your doctor will decide which procedures are most suitable for you. Note: if your own blood will be collected or donated in preparation for surgery, you should stop taking herbal supplements at least one week before the scheduled collection or donation. Some herbal or dietary supplements interfere with the blood's ability to clot.

Where can I donate autologous blood?

Autologous blood can be set aside at the American Red Cross. Your doctor can arrange the donation. The Cleveland Clinic Blood Bank can help make similar arrangements for patients who live in an area of the country that is not served by the American Red Cross.

Is my blood tested for AIDS & hepatitis?

All units of blood are tested. The tests do not diagnose AIDS and hepatitis, but they do indicate past exposure to the viruses that cause these diseases. The blood you donate to yourself also will be tested for antibodies to these viruses.

If I donate my own blood, are all of the blood components I receive mine?

In general, only red blood cells may be deposited ahead of time in either an autologous blood program or a directed blood program. Blood components, including platelets, plasma and cryoprecipitate, are dispensed from the standard inventory.