What is a Blood Transfusion?
History of Blood TransfusionThe first successful blood transfusion happened in 1665 when the British physician Richard Lower kept a dog alive by transfusing blood from other dogs. In 1818, the first human blood transfusion happened when the British obstetrician James Blundell transfused blood to a patient for treating postpartum hemorrhage.
It was the 20th century that saw the refinement of this procedure when Karl Landsteiner, an Austrian physician discovered the first three human blood groups. Reuben Ottenberg performed the first blood transfusion after blood typing and cross-matching.
The Rh blood group system was discovered by Karl Landsteiner, Alexander Wiener, Philip Levine and R.E. Stetson.
Significant milestones included testing of blood for HIV-1 and HIV-2 antibodies in 1992. In 2002, the Food and Drug Administration (FDA) licensed the Nucleic Acid Amplification Test (NAT) for HIV and Hepatitis-C virus.
ProcedureDuring the procedure, a hypodermic needle or cannula is inserted in a vein either near the elbow or the wrist. This is then connected to the blood for transfusion. The procedure usually takes around 3-4 hours during which time the patient is monitored for adverse reactions. In some cases, the patient may present with reactions such as mild fever, itching and hives, headache and nausea. Usually an antihistamine such as promethazine hydrochloride (Phenergan®) is administered to counter the adverse effects.
The entire procedure is usually monitored by a nurse. One can take a blood transfusion either lying down or sitting. After the transfusion, the needle and IV line are removed. One may develop a tiny bruise with some mild swelling in the area. A plaster is usually required for some time. Swelling and bruising usually go away on its own. In some cases, a heparin sodium gel (Thrombophob®) may be prescribed if the swelling is painful. This will reduce the swelling and ease the circulation.
A blood transfusion is usually a daycare procedure unless the patient has been hospitalized for sickness or surgery.
When is a Blood Transfusion Required?The normal Hb range for men is between 13.5 to 17.5 grams per deciliter. For women, the normal range is between 12.0 to 15.5 grams per deciliter.
A blood transfusion becomes necessary when a person loses blood in an accident, childbirth or surgery. Blood transfusion is also required when anemia is present and the patient has failed to respond to other treatments. People with inherited blood disorders like thalassemia, sickle cell anemia and diamond-blackfan anemia require lifelong blood transfusions for survival.
Blood SafetyEvery country has blood safety legislations. In India, the National Aids Control Organization (NACO, Department of Health and Family Welfare) is primarily responsible for regulating blood safety, blood collection, blood banks and testing.
Some of NACO’s aims include:
- Making safe blood available within an hour of the requirement.
- Raising voluntary donation to 90% from the existing 52%.
- Stringent quality control for blood screening.
- Quality transfusion management.
- Set up model blood banks.
- External accreditation for blood banks.
Blood Transfusion AlternativesResearchers have been working on producing synthetic blood which will be relatively risk free and safe.
In some cases before surgery or medical procedures, one can go for autologous blood transfusion where the patient’s blood is collected and then re-transfused after surgery. This helps avoid the risks from blood transfusion. However, this may not always be a feasible alternative.
There are certain medications available to stimulate the production of red blood cells in the bone marrow. This is known as erythropoietin. People who undergo hemodialysis and suffer from low Hb usually take this medication.
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Two studies shed new light on the prevalence of transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), the number one and two leading causes of blood transfusion-related deaths in the United States.