Background Information on Blood Transfusion
Safety concerns, rising costs, and blood shortages are some of the reasons behind the move towards blood management and promoting autologous infusion. The prevailing medical consensus is summarized by Isbister:
Expand/Collapse All Supporting Articles
“Altruistically donated allogeneic blood transfusion should only be used as therapy when there is evidence for potential benefit, there are no alternatives, a quality product is available and the risks are appropriately considered and balanced against the benefits.”
- Vivacqua A, Koch CG, Nowicki ER, Houghtaling PL, Blackstone EH, Sabik JF. Morbidity of Bleeding After Cardiac Surgery: Is It Blood Transfusion, Reoperation for Bleeding, or Both? Ann Thorac Surg. 2011 June;91(6):1780-1790.
- Bilgin YM, van de Watering LMG, Versteegh MI, van Oers MH, Vamvakas EC, Brand A. Postoperative complications associated with transfusion of platelets and plasma in cardiac surgery. Transfusion 2011;51.
- Glance LG, Dick AW, Mukamel DB, Fleming FJ, Zollo RA, Wissler R, et al. Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery. Anesthesiology 2011 February;114(2):283-29.
- Transfusion-Alternative Strategies Video Presentation - available at Perfusion.com (7 November 2010)
- Moskowitz DM, McCullough JN, Shander A, Klein JJ, Bodian CA, Goldweit RS et al. The Impact of Blood Conservation on Outcomes in Cardiac Surgery: Is It Safe and Effective? Ann Thorac Surg. 2010;90:451-458
- Less blood is really more, transfusion critics say (17 August 2010)
- Neergaard L. Tests aim to settle if fresher blood works better (26 July 2010)
- New threats to US blood supply (24 May 2010)
- Shining a light on the safety of blood transfusions (10 Nov. 2009)
- South Carolina's Beaufort Memorial reducing transfusions due to risks (8 Sept. 2009)
- Alter HJ, Klein HG. The hazards of blood transfusion in historical perspective. Blood. 2008 Oct 1;112(7):2617-26.
- Many blood transfusions may increase risks, doctors warn :UK study found dangers for heart surgery patients (24 Apr. 2008)
- Global blood banking and blood products market to reach 31.7 billion dollars by 2010, according to new report by Global Industry Analysts, Inc. (17 Apr. 2008)
- Isbister JP. Clinicians as gatekeepers: what is the best route to optimal blood use? Dev Biol (Basel). 2007;127:9-14.
Providing safe blood for transfusion remains a challenge. Despite advances in preventing transmission of hepatitis B, hepatitis C, and AIDS/HIV, transfusion-transmitted bacterial infection remains a significant risk.Supporting Articles
- Blood-clotting drug given to wounded soldiers can cause heart attacks (15 Nov. 2010)
- Study claims old blood boosts infection risks | Another report | Australian report
- Kansas City patient's case highlights risks of tainted platelets (27 Oct. 2008)
- Platelets infected with E. coli contributed to patient's death (28 July 2006)
- Eder AF, et al. and the American Red Cross Regional Blood Centers. Bacterial screening of apheresis platelets and the residual risk of septic transfusion reactions: the American Red Cross experience (2004-2006). Transfusion 2007;47 (7):1134-42.
Many adverse events are associated with the transfusion of allogeneic blood products:
- Blajchman MA, Vamvakas EC. The continuing risk of transfusion-transmitted infections. N Engl J Med 2006 Sep 28;355(13):1303-5.
- Blajchman MA. The clinical benefits of the leukoreduction of blood products. J Trauma. 2006 Jun;60(6 Suppl):S83-90.
- Hod EA, Zhang N, Sokol SA, Wojczyk BS, Francis RO, Ansaldi D, et al. Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation. Blood. 2010 May 27;115(21):4284-4292.
Viral risks such as HIV, although extremely rare, have not totally disappeared:
- First case of HIV from blood transfusion traced to Missouri donor (22 Oct. 2010)
- HIV/AIDS rate hits 3% in DC, higher than some West African countries (15 Mar. 2009)
- Libya sentences medics to death for allegedly infecting 100s of children with HIV (19 Dec. 2006)
- CDC backs HIV test for all between 13-64
- UNAIDS: Important progress seen in tackling AIDS, but epidemic continues to outpace response (30 May 2006)
- HIV/AIDS in China: from high-risk groups to general population
- China AIDS survey (1985–2003)
There is growing evidence that human herpesvirus 8 (HHV-8), previously thought unlikely to be transfusion-associated, may be transmissible by blood transfusion:
- HHV-8 found transmissible by blood transfusion (27 Sept. 2006)
There are now multiple reported cases of transfusion-transmitted Chagas disease (caused by the parasite caused by Trypanosoma cruzi) in the USA and Canada, with continued calls for blood banks to screen for the T. cruzi parasite:
- Chagas' disease parasite found in desert blood samples (17 Aug. 2007)
- Young C, Losikoff P, Chawla A, Glasser L, Forman E. Transfusion-acquired Trypanosoma cruzi infection. Transfusion 2007 Mar;47(3):540-4.
Other risks such as variant Creutzfeldt Jakob Disease (vCJD) remain worrisome. Blood centers worldwide have instituted criteria to reject donors who may have been exposed to vCJD. There are now four suspected cases in the United Kingdom and donors whose blood was transfused to people who died of vCJD have been warned that they may be carrying the disease.
- Italy reports human case of mad cow disease (22 July 2010)
- More people could have 'mad cow disease' than previously thought (18 Dec. 2009)
- UK could import more blood to counter BSE risk from transfusions (18 Feb. 2009)
- Scientists warn of 1st ever case of vCJD from plasma (15 Feb. 2009)
- 'Second wave' of mad cow disease could hit Britain, scientists warn (7 Dec. 2008)
- vCJD may be transmitted more efficiently via transfusion than thought (6 Sept. 2008)
- Houston F, McCutcheon S, Goldmann W, Chong A, Foster J, Siso S, et al. Prion diseases are efficiently transmitted by blood transfusion in sheep. Blood. 2008 Jul 22. [Epub ahead of print]
- Britain may 'never be rid of vCJD threat' without screening (24 Sept. 2007)
- UK: Warning on vCJD screening(24 Sept. 2007)
- Interview with Professor James Ironside (National CJD Surveillance Unit, Edinburgh)
- Fourth case of transfusion-associated vCJD infection in the United Kingdom (editorial). Euro Surveill. 2007 Jan 18;12(1).
- UK Health Protection Agency: 4th case of transfusion-associated vCJD (18 Jan. 2007)
- Should we still be worried about vCJD? (10 Jan. 2007)
- UK: 24 patients transfused with vCJD contaminated blood at substantial risk (8 Dec. 2006)
- TraQ's vCJD clearinghouse (latest updates)
- Special report: BSE and CJD (Guardian Unlimited - ongoing updates)
- Blood transfusions could transmit vCJD (27 Mar. 2006)
- 3rd transfusion-related vCJD case in UK (BBC, 9 Feb. 2006)
- UK Health Protection Agency: New case of vCJD associated with blood transfusion (Press release, 9 Feb. 2006)
- vCJD warning for blood recipients (17 Nov. 2005, BBC)
- UK national CJD Surveillance Unit: 2004 Annual Report(7 Nov. 2005)
- News report (14 Nov. 2005)
- 2nd case of possible transmission of vCJD via transfusion in UK (22 July 2004)
- ~100 UK blood donors warned they may have vCJD (BBC, 20 July 2005)
- Assessing the implications for blood donors if recipients are infected with vCJD(UK DOH, 20 July 2005)
Because West Nile Virus (WNV) can be transmitted by blood transfusion and most patients with WNV infection are likely to be asymptomatic, a blood donor screening test for WNV was implemented in July 2003.
- Viremic blood donors in USA (CDC)
- Eastern Ontario blood donor tests positive for WNV, triggering single-donor testing in area (28 July 2005)
- TraQ's WNV clearinghouse (latest updates)
- Transfusion-associated transmission of WNV - Arizona, 2004 (MMWR, 17 Sept. 2004)
Transfusion-related acute lung injury (TRALI) remains a life-threatening complication of transfusion:
- Transfusion-Related Acute Lung Injury (TRALI) (Canadian Blood Services)
- Blood Donations From Previously Pregnant Women Restricted
- Bueter M, Thalheimer A, Schuster F, Bock M, von Erffa C, Meyer D, Fein M. Transfusion-related acute lung injury (TRALI) - an important, severe transfusion-related complication. Langenbecks Arch Surg. 2006 Aug 15;
- Fitzmaurice GJ, Parissis HD. Platelet Transfusion Associated With Acute Lung Injury After Coronary Artery Bypass Grafting Ann Thorac Surg. 2011 June;91(6):1977-79.
- Swanson K, Dwyre DM, Krochmal J, Raife TJ. Transfusion-related acute lung injury (TRALI): Current clinical and pathophysiologic considerations. Lung 2006 May-Jun;184(3):177-85.
- Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood. 2003 Jan 15;101(2):454-62.
- Transfusion-related acute lung injury (TRALI)--under-diagnosed and under-reported. (editorial) Br J Anaesth 2003 May; 90(5):573-6.
Transfusion associated circulatory overload (TACO) is a condition due to a rapid transfusion of a large volume of blood or blood products. The primary symptoms of TACO are dyspnea, orthopnea, "wet lungs" from capillary leakage, peripheral edema, and increased blood pressure due to too much systemic circulating volume from "tanking a patient up".
- Narick C, Triulzi DJ, Yazer MH. Transfusion-associated circulatory overload after plasma transfusion. Transfusion. 2011 Jul 18. doi: 10.1111/j.1537-2995.2011.03247.x. [Epub ahead of print]
- Li G, Rachmale S, Kojicic M, Shahjehan K, Malinchoc M, Kor DJ, Gajic O. Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients. Transfusion. 2011 Feb;51(2):338-43. doi: 10.1111/j.1537-2995.2010.02816.x. Epub 2010 Aug 17.
- Dr Hazel Tinegate Transfusion-associated circulatory overload
- Transfusion Associated Circulatory Overload 13 July 2011
- Skeate RC, Eastlund T. Distinguishing between transfusion related acute lung injury and transfusion associated circulatory overload. Curr Opin Hematol. 2007 Nov;14(6):682-7.
Transfusion-associated immunomodulation (TRIM) has been reported since the 1970s. Evidence-based approaches suggest that an adverse TRIM effect probably does exist, and even if the effect is small, it represents a clinically important complication of transfusion:
- Blajchman MA. Transfusion immunomodulation or TRIM: What does it mean clinically? Hematology 2005 Sep-Oct;10 Suppl 1:208-14.
- Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? (review) Blood 2001 Mar 1;97(5):1180-95.
Human errors present more of a risk than transmissible diseases as shown by the Serious Hazards of Transfusion (SHOT) reports from the UK. Human error also results in many recalls of blood products that were mistakenly issued from blood suppliers.
- Problems persist with American Red Cross Blood Services (17 July 2008)
- Inexperienced staff and faulty machinery among excuses for woman's death from blood loss (Australia, 5 March 2008)
- FDA fines ARC $4.6 million for distributing "unsuitable blood products - ARC statement
- Man given wrong blood transfusion in Florida hospital dies (21 Jan. 2008)
- U.S. hospital errors continue to rise (2 April 2007)
- Canadian hospital to contact 3000 ex-patients to get tests for HIV and HBV due to problems with sterilization of surgical equipment (14 Apr. 2007)
Misidentification leading to blood of the wrong blood group being transfused can result in life-threatening transfusion reactions:
- Scotland: Blood centre to tighten its IS issuing rules after baby issued "wrong" blood (leucocyte-depleted but not CMV-negative, as required in policy)
- FDA fines ARC $4.2 million for failure to meet established blood safety laws (8 Sept. 2006)
- Blood transfusion implicated in death of S.C. woman (28 Feb. 2005)
Costs have risen due to adoption of improved screening tests for transmissible diseases and government-mandated patient and hospital notification requirements for blood products identified as having increased risk for disease transmission. While such advances improve safety, they also increase the cost of obtaining and processing blood. See, for example:
- Stokes ME, Ye X, Shah M, Mercaldi K, Reynolds MW, Rupnow MF, Hammond J. Impact of Bleeding-related Complications and/or Blood Product Transfusions on Hospital Costs in Inpatient Surgical Patients BMC Health Services Research 2011 May;11:135.
- New Published Study Finds the Cost of Blood Transfusions is Significantly Under-Estimated, Establishes True Cost at $522 to $1,183 Per Unit (5 April 2010)
- Rising blood costs and safety concerns motivate hospitals to limit use of transfusions(29 Oct. 2009)
- Tidbit in article: The cost of a unit of blood has more than doubled over the past decade, and hospitals spend an estimated $25 billion to buy, process and trans- fuse about 30 million units a year.
- Fewer transfusions lowers costs, helps patient (5 May 2008)
- The business of blood (Lincoln Journal Star, 30 Sept. 2007)
- Shander A, Hofmann A, Gombotz H, Theusinger OM, Spahn DR. Estimating the cost of blood: past, present, and future directions. Best Pract Res Clin Anaesthesiol 2007 Jun;21(2):271-89.
- Cost of outpatient blood transfusion in cancer patients (J Clin Oncol I 2000 July;18(14): 2755-61)
- Comparative costs of blood conservation. Table 12-7 in:
- Lee LY, DeBois WJ, Krieger KH, Isom OW. Transfusion Therapy and Blood Con- servation (Chapter 12). In: Cohn LH, Edmunds LH Jr, eds. Cardiac Surgery in the Adult. New York: McGraw-Hill, 2003:389400.
- Rueda A. Rethinking blood shield statutes in view of the hepatitis C pandemic and other emerging threats to the blood supply.J Health Law 2001 Summer;34(3):419-58.
- Wilson K, and Paul C. Hébert PC. The challenge of an increasingly expensive blood system. CMAJ 2003 Apr29; 168 (9):1149-50.
Various blood conservation strategies have been used to reduce costs, e.g.,
- The Society of Thoracic Surgeons Blood Conservation Guideline Task Force; Ferraris VA, Ferraris SP, Saha SP, Hessel EA 2nd, Haan CK, Royston BD, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the society of thoracic surgeons and the society of cardiovascular anesthesiologists clinical practice guideline. Ann Thorac Surg 2007 May;83(5 Suppl):S27-86.
- Waters JR, Meier HH, Waters JH. An economic analysis of costs associated with development of a cell salvage program. Anesth Analg 2007 Apr;104(4):869-75.
- New tactics save blood. Reducing transfusions cuts costs and benefits patients, hospital says (8 Jan. 2007)
To learn how the Hemobag® can reduce costs, see the Cell Washer ATS Waste Calculator & Cost Estimator
Blood shortages exist in the United States and worldwide. In many industrialized countries 5% or less of the eligible population are blood donors. Screening for transmissible diseases and deferral policies for vCJD designed to improve safety have contributed to shrinking the donor pool. Blood centers are increasingly forced to encourage blood donation with giveaways and the AABB operates a National Blood Exchange to help ensure blood is moved where it is needed.
- New guidance for emergency blood provision Nursingtimes.net (12 November 2010)
- Blood banks brace for donation drop (14 Aug. 2009)
- Sweden reports nationwide blood shortage (26 May 2009)
- Blood donations slow as economy slides (22 Feb. 2009)
- Canada - 40% drop in inventory forces rationing of blood supply - more donors needed urgently (29 Oct. 2008)
- Appeal for more blood donor buses as NYC blood supply at dangerously low levels (13 Aug. 2008)
- Hospitals delay more surgeries. Severe blood shortage continues; donations encouraged (26 July 2008)
- ARUP Blood Services summer car giveaway
- Blood for oil, literally: Donors are pumping out blood to make life easier at the gas pump (3 June 2008)
- Blood supply running low in Utah as donors sell plasma (10 June 2008)
- Florida: Blood shortage puts some surgeries on hold (1 Apr. 2008)
- Incentives draw in donors. They're costly, but necessary as blood centers try to match supply with demand. (23 Dec. 2007)
- Blood for military in critical shortage (19 Dec. 2007)
- Zou S, Musavi F, Notari EP 4th, Fang CT; ARCNET Research Group. Changing age distribution of the blood donor population in the United States. Transfusion. 2007 Nov 13; [Epub ahead of print]
- S.E. Michigan in jeopardy from critical blood shortage (22 Aug. 2007)
- Blood donor pool thinning (Aug. 5, 2007)
- Summer blood shortage prompts donation plea (Aug. 7, 2007)
- Riley W, Schwei M, McCullough J. The United States' potential blood donor pool: estimating the prevalence of donor-exclusion factors on the pool of potential donors. Transfusion 2007;47 (7), 1180-8.
- As summer approaches, Red Cross blood supplies reach dangerous levels (30 May 2007)
- New rules may shrink ranks of blood donors (10 Jan. 2007)
- CJD fears prompt blood donor ban (BBC)
- AABB Blood FAQ
For these reasons the global medical community has moved away from allogeneic blood and towards autologous infusion. When blood is required, the safest blood is almost always the patient's own autologous blood.
The Hemobag® is a medical device developed by medical professionals with years of experience in cardiac, thoracic and vascular surgery, to assist in salvaging the patient's own whole blood in the perioperative setting.
The Hemobag® makes it easy to get the benefits of concentrated hyperoncotic whole blood with the use of any extracorporeal circuit used in surgery.
With The Hemobag® patients receive their own concentrated whole blood quickly and receive less allogeneic blood with its associated risks.
The Hemobag® takes patients one step closer to blood free surgery by making their own Autologous Whole Blood rapidly available for infusion at the end of the procedure.
On This Page:
- Other Factors
- The Hemobag®
Blood Myths (NSW Govt., Australia):
- Myth 1: “Blood, it’s safer than it’s ever been”
- Myth 2: “A blood transfusion will get my patient home sooner”
- Myth 3: "Blood transfusions improve healing"
- Myth 4: "Autologous blood (pre-donated) is risk-free"
- Myth 5: "Blood, it's free anyway"