Blood Product Transfusion

Childhood cancer patients sometimes need blood transfusions when their bodies cannot make enough blood cells.

Cancers of the blood, such as leukemia and lymphoma, can affect the bone marrow, the soft inner portion of bones where blood cells are made. Different treatments for cancer can also affect the blood and bone marrow.

• Many chemotherapy drugs may affect how the bone marrow functions.
• Radiation therapy given to a large area of bone can harm the bone marrow.
• Surgery can lead to blood loss.
• Patients who receive a hematopoietic cell transplant (also known as bone marrow transplant or stem cell transplant) get large doses of chemotherapy and/ or radiation therapy that destroy bone marrow.

Role of the Blood

The heart pumps blood through a network of arteries and veins throughout the body. Blood carries oxygen and nutrients to the body’s organs and tissues.

Blood is made up of different components or parts:

• Red blood cells – These cells carry oxygen from the lungs to the body's organs and tissues. They also help the body get rid of carbon dioxide and other waste products.
• Platelets – These cells prevent bleeding in the body by helping the blood to clot.
• White blood cells – These cells help the body fight infections.
• Plasma – Plasma is the liquid component of blood. It contains proteins such as albumin and globulin, along with coagulation factors that help the blood to clot.

Types of Blood Product Transfusions

Red blood cells and platelets are the most commonly transfused products. Whole blood is rarely, if ever, used. When donors give whole blood, it is usually separated into parts.

Red blood cell transfusions

Childhood cancer patients with severe anemia may need transfusions of red blood cells. Anemia occurs when the body has a lower than normal number of red blood cells. It can also occur if red blood cells don’t have enough hemoglobin, an iron-rich protein in red blood cells that carries oxygen.

A red blood cell transfusion may take 2- 2 ½ hours. The time required for the procedure depends on the patient’s weight and the volume of blood product needed by the patient.

Platelet transfusion

Childhood cancer patients sometimes need platelet transfusions if they have low platelet counts, a condition called thrombocytopenia.

A platelet transfusion may take 1-1 ½ hours. It depends on the patient’s weight and the transfusion volume.

White blood cells (granulocytes)

White blood cell transfusions are rare. They are used for patients with severe infections that don’t respond to antibiotics. Granulocytes are the type of white blood cell that is transfused.

Plasma transfusion

Plasma transfusions are given to childhood cancer patients who may be having problems with bleeding excessively. Plasma contains coagulation factors that help the blood to clot.

Getting a Blood Transfusion

Most transfusions are done in a hospital setting, often in the hospital’s chemotherapy room, during a surgical procedure, or at a patient's bedside.

Patients should prepare to wait a few hours for their blood transfusion to begin. Once the doctor places an order for a blood product, the blood bank staff must go through a process to ensure the patient receives the appropriate product. Then the blood product must be delivered to the procedure area. That process can take 2 hours or more. If the patient is an outpatient, the family may want to find other things to do at the hospital during this period.

The transfusion itself may take 1-2 hours or longer. The time length depends on the type of transfusion, the volume of the product, and the weight of the patient. The care team can give families information specific to their child.

• When it is time for the transfusion, the staff will check the patient’s blood pressure, pulse, and body temperature.
• If everything is OK, the staff will order the blood product.
• When the product arrives, the staff will then ensure that the patient’s medical record number, armband number, blood unit number, and blood type correspond. They will also check the blood product’s expiration date.
• If the patient has a central venous access device, he or she will probably receive the blood transfusion through the device. If not, patients will receive the blood through a peripheral IV.
• The blood product bag will be hung upside down from an IV pump that controls the speed of the flow.
• During the transfusion, the staff will monitor the patient carefully for signs and symptoms of a reaction to the blood product.
• After the transfusion, the nurse will check the patient’s vital signs again. If the patient has an IV, it will be removed.
• The nurse will let the family know about signs and symptoms to watch out for and report.

Risks of blood transfusions

Most blood transfusions go smoothly. However, some patients may have reactions to transfusions. In some cases, the reaction can be treated and the transfusion can continue. In other cases, the care team will stop the transfusion.

Symptoms of a reaction can include:

• Itching
• Hives
• Flushing skin
• Swelling in the face, near the eyes and mouth
• Trouble breathing
• Fever
• Chills
• Nausea (feeling sick to the stomach)
• Changes in pulse or blood pressure

In rare cases a severe reaction called a hemolytic transfusion reaction may happen. It occurs if the blood type the patient is given during a transfusion doesn't match or work with the patient’s blood type. The body attacks the new blood cells, which then produce substances that can harm the kidneys.

Symptoms include:

• Fever 
• Chills
• Back and/or flank pain
• Low blood pressure
• Dark urine

The nurse will stop the transfusion at the first sign of this reaction.

Parents should make sure to report any of these signs and symptoms to the care team.

Where Blood Products Come From

Hospitals receive blood products from blood centers, which are facilities that collect, prepare, store, and distribute blood for transfusion. Some blood centers are freestanding. Others are part of a hospital.

Blood products are most often donated by volunteer blood donors. Sometimes families donate blood for a specific patient. In some cases, the patient’s own blood can be used. But that is usually not possible for childhood cancer patients.

A patient must receive a blood product that works with his or her blood type. If the blood product isn’t compatible, antibodies in the blood will attack the donor blood and make the patient ill.

Every person has a blood type – O, A, B, or AB. It is either Rh-positive or Rh-negative. The types of blood are:

• O negative or O positive
• A negative or A positive
• B negative or B positive
• AB negative or AB positive

Blood banks type and match blood products to make sure they are compatible with the recipient’s blood.

Safety of Blood Products

The Food and Drug Administration (FDA) regulates blood donations. Blood banks take several precautions to ensure the safety of the blood supply.

• Blood donors are asked specific questions about risk factors that could affect the safety of the donation. They are not allowed to donate if risk factors are found.
• Qualified blood donors and their donated blood are tested for several infectious agents including HIV, hepatitis B and C, Zika virus, human T-lymphotropic virus (HTLV), West Nile virus, syphilis, and Trypanosoma cruzi, the infectious agent that causes Chagas disease. This testing occurs whether or not risk factors are found during the interview. If the blood is positive for one of these infections, the blood is discarded.
• Blood may also be screened for certain antibodies.

Because of the stringent screening involved, blood products in the United States are very safe. Chances of getting an illness because of a blood transfusion are rare. 

For more information about blood safety, visit the CDC's Blood Safety Basics.