When your child needs a red blood cell transfusion

What is a transfusion?

Human blood can be used to make more than 30 different products. Putting some or all of these blood products into someone’s body is called a transfusion. The blood product is usually given through a small needle placed into a vein.

Why would a child need a transfusion?

• Newborn babies sometimes need transfusions if they were born prematurely (before their due date).
• Your child may need a transfusion during major surgery or to treat a medical condition. Sometimes in emergency situations, such as when there has been sudden bleeding, transfusions have to be given. They can also help a person recover from a serious illness or injury. 
• Sometimes, people need more than one transfusion because they are missing important parts of their blood.

What are the parts of blood and what do they do?

Red blood cells carry oxygen to all tissues in the body so that they stay alive and work well. If your child has had a lot of bleeding, or is not making enough red blood cells or hemoglobin (also known as anemia), they may need a red blood cell transfusion. This helps prevent more damage.

Platelets are very tiny cell particles that help prevent and stop bleeding.

Plasma is the yellow liquid around the red blood cells and platelets.

• Plasma helps blood clot (become thick). It can be used with platelets to prevent or stop bleeding, or to replace the plasma in children with certain severe diseases.
• Other products can be made from plasma and can be used to treat special bleeding problems, such as hemophilia.
• Plasma is also used to make a product called intravenous immunoglobulin (IVIG).This helps the body fight infection and is used to treat many medical conditions.

Other blood products are used in very specific cases. If your child needs them, your doctor will discuss them with you in detail.

Where does donated blood come from?

Canadian Blood Services and Héma-Québec collect blood from volunteer donors. Before it’s used, blood is tested and divided into separate parts or units. If your child needs a transfusion, they will get only the part that they need.

Are there risks to having a blood transfusion?

Some problems can happen from a blood transfusion:

• Mismatch of blood types between donor and the person receiving the donation. This is now very rare, especially in children. Special kinds of blood products that are a match for almost everyone are kept for emergency transfusions.
• Allergic reactions, including rashes and hives. They are usually mild and easily treated. More serious allergic reactions are rare.
• A fever usually means the body is reacting to white blood cells or plasma proteins from the donor’s blood. The fever is usually not severe and can be easily treated. If your child has had a high fever in the past after or during a transfusion, you should talk to the doctor.
• Transfusion-related acute lung injury (TRALI) is a rare but serious problem that affects the lungs. It starts with shortness of breath and low oxygen levels in the blood and lungs. This reaction starts quickly, either during the transfusion or within 6 hours of completing the transfusion.

Can my child get a disease from a transfusion?

Although blood can never be 100% safe, blood donors are carefully screened and their blood is tested. The risk of infection from a transfusion is very low.

• The risk of human immunodeficiency virus (HIV) infection has dropped to 1 in every 21 million transfusions in Canada.
• The risk of hepatitis B infection from a transfusion is 1 in 7.5 million transfusions in Canada.
• The risk of getting hepatitis C is even smaller now that a new test can find the virus right in the blood (less than 1 in 12.6 million transfusions).

For products made from plasma (such as albumin and immunoglobulin), there are extra steps taken to get rid of any viruses that may remain after testing.

Does my child have to receive blood from an unknown person?

That is what usually happens and is generally very safe. Sometimes one of the following is also an option:

• Autologous blood donation means that the patient donates their own blood before surgery. This has been done safely with children, elderly people, pregnant women and even people with heart disease. It is not an option for everyone. Very small children and those with certain medical conditions cannot give their own blood.
• Occasionally, parents can do a directed donation of blood to be used only for their child. However, there are often reasons why this is not the best choice. Ask your doctor about the risks and benefits, and whether this choice is possible. Like all blood donors, you will need to be tested to find out if you are a suitable donor.
• There may be alternatives to transfusion, such as the use of saline or nonplasma-derived clotting factor concentrates made with new DNA technology, or other manufactured products. There are also procedures, such as blood salvaging, which may be an option for your child in certain situations. It is important to discuss the details with your child’s doctor.

How do I decide about a transfusion?

As long as it isn’t an emergency situation, your doctor or another health professional will explain why a transfusion is needed, what components of blood are needed, and the risks and benefits. This is called informed process. You will be asked to sign an informed consent form.

Should a blood transfusion record be kept?

Yes. A record will be kept in the hospital, but before you leave, make sure you receive something in writing that says your child received blood or blood products. This is important medical information that should be kept with your child’s health information.