What You Need to Know About Blood Transfusions and IBD

If Too Much Blood Is Lost, A Transfusion Might Be Needed

Blood Bag
A blood transfusion is not uncommon for people with IBD. A transfusion is one way to treat the loss of too much blood. Photo © Vichaya Kiatying-Angsulee

There may be times when people with inflammatory bowel disease (IBD) would need to receive blood from a donor, such as during a surgical procedure or if too much blood is lost through bleeding in the gastrointestinal tract. There are risks involved with receiving a blood transfusion, but in general it is a procedure that is well-tolerated and, as we all know, it can save lives.

Blood Donation

Typically, blood is donated by volunteers who are screened and “accepted” to give blood.

The screening process includes questions about overall health and about any risk factors for disease. Blood is only taken from donors who are designated as healthy enough to do so. The donated blood is tested to determine type (A, B, AB, or O) and screened for the presence of the hepatitis virus (B and C), HIV, HTLV (human T-lymphotropic viruses), West Nile virus, and Treponema pallidum (the bacteria which causes syphilis).

Blood can also be taken and stored for one’s own future use, or be donated by a relative. Most often, a person’s own blood is drawn and stored in advance of a surgery where a transfusion may be needed. This, of course, can only be done in cases where the need is anticipated. Relatives may also donate blood for direct use by a patient, although this is not typically considered any safer than blood from a volunteer.

Procedure

When a patient needs blood, a suitable match is found among donor blood.

Cross-matching is done to ensure that the immune system of the person receiving the blood will not reject it. Blood from the donor is matched to the type and Rh factor of the recipient. The cross-matching is verified several times, including at the bedside of the patient, to ensure that the correct blood type is given.

A blood transfusion is done intravenously, and typically 1 unit (500 ml) of blood is given over about 4 hours. Other drugs such as an antihistamine or acetaminophen may also be given to help prevent a reaction to the transfusion.

Possible Adverse Events

Febrile Non-hemolytic Transfusion Reaction. The most common adverse event in blood transfusions is a febrile non-hemolytic transfusion reaction. This reaction may cause symptoms of fever, chills, and shortness of breath, but these are self-limiting and do not lead to a more serious complication. This event occurs in approximately 1% of transfusions.

Acute Hemolytic Transfusion Reaction. In an acute hemolytic reaction, antibodies from the immune system of the patient receiving the blood attacks the donor blood cells and destroys them. Hemoglobin from the donor blood is released during the cell destruction, which may lead to kidney failure. The risk of this event is estimated at 1 per every 12,000 to 33,000 units of blood transfused.

Anaphylactic reaction. This is a rare but severe allergic reaction which may be caused by the recipient reacting to the donor’s plasma.

This is potentially life-threatening and can occur during the transfusion procedure or several hours afterwards. The risk of an anaphylactic reaction is approximately 1 per 30,000-50,000 transfusions.

Transfusion-associated graft-vs-host disease (GVHD). This very rare complication primarily occurs in severely immunosuppressed recipients. Incompatible white blood cells from the donor blood attack the recipient’s lymphoid tissue. GVHD is almost always fatal, but this complication may be prevented with the use of irradiated blood. Blood may be irradiated if it is going to be given to a recipient who is at risk for GVHD.

Infection.
Viral infection. While the risk of infection is decreased due to the screening process that donors and donated blood undergo, there is still a risk of these infections. The risk of acquiring a viral infection from a transfusion of one unit of blood is approximately:

  • Hepatitis B: 1 in 250,000
  • Hepatitis C: 1 in 1.9 million
  • HIV: 1 in 2.1 million
  • HTLV: 1 in 2 million

Bacterial infection. A bacterial infection can be transmitted if there is bacteria in the donated blood. Blood can become contaminated with bacteria during or after collection, or during storage. The risk of a severe infection is approximately 1 in 500,000 transfusions.

Other diseases. Other viruses (cytomegalovirus, herpesviruses, Epstein-Barr virus), diseases (Lyme disease, Creutzfeldt-Jakob disease, brucellosis, leishmaniasis), and parasites (such as those which cause malaria and toxoplasmosis) can potentially be transmitted through a blood transfusion, but these are rare.

Sources:

Pall Corporation. "Blood Transfusions: Knowing Your Options." BloodTransfusion.com 2009. 17 Jul 2009.

Continue Reading