Transfusion Steps and Possible Side Effects

Most blood transfusions are given in a clinic or hospital. Depending on where you’re getting a blood transfusion, the process may be a little different.

Here is a general overview of what it’s like to get a blood transfusion. 

• Before the doctor prescribes blood products, you will be asked to read and sign your informed consent (permission) form. This means you understand the risks and benefits of getting a transfusion and what other options you might have. Make sure someone has explained these things to you. Informed consent may not apply if it is a life-threatening emergency.
• Lab work is done to check your blood type. Sometimes other blood tests are done, like testing for antibodies.
• The blood bank will find a donated blood product that matches your blood type.
• When the blood (or blood product) is ready, someone will check your blood pressure, heart rate, and temperature.
• You will have an intravenous line (IV) placed in your arm if you don’t already have an IV or central line.
• The nurse will do several safety checks to make sure the blood product is the right one for you. The nurse should also remind you of what to look out for during the transfusion.
• The nurse will start the blood transfusion in your vein slowly for the first 15 minutes or so. This is to make sure you don’t have a reaction.
• After about 15 minutes, the nurse will increase the rate of the transfusion.

How long the transfusion takes depends on what kind of blood product you’re getting and how you’re doing with the transfusion.

For example, whole blood and packed red blood cells take between 2 to 4 hours to complete. But platelets and plasma can be transfused quickly, usually less than 30 minutes. If you have certain conditions like heart failure, they may run it slower so that your body isn’t getting too much fluid at once.

Sometimes blood transfusions can be given at home by a visiting nurse. This happens rarely and there are certain rules on who can and can’t get a transfusion at home. Home transfusions follow the same safety standards as hospital transfusions. Not all home health agencies provide this service.

Possible side effects of blood transfusions

Most people who get a blood transfusion have no problems. But some people do, and these are called transfusion reactions.

The are several types of transfusion reactions. Some are mild and don’t need treatment, and others are more serious. Most transfusion reactions happen during a transfusion, but others might not happen for several days.

Transfusion reactions

• Allergic reactions. This is the most common reaction and is usually mild with itching or hives. It happens when your immune system reacts to proteins in the blood product. Antihistamine medicine is usually enough to treat the reaction. If there are no other symptoms, the transfusion is usually continued.
• Febrile reactions. This is a common reaction. A fever can occur during or up to 24 hours after the transfusion. This happens because the immune system reacts to white blood cells in the blood product. People may also have a headache, nausea, chills, or a general feeling of discomfort. Acetaminophen (Tylenol) can help. If the fever happens during the transfusion, is mild, and there are no other symptoms, the transfusion may be continued. People who are at risk for a febrile reaction may be given leukoreduced blood products. Leukoreduced blood products have the white blood cells removed and can help prevent febrile reactions.
• Transfusion-related acute lung injury (TRALI). This is a very rare reaction and usually happens to people who are very sick in the hospital. The main symptom is trouble breathing.
• Acute immune hemolytic reaction. This is a very rare but serious reaction that develops when the donor and patient blood types don’t match. It usually happens quickly, within a few minutes after the transfusion starts. This is why so many safety checks are done to make sure the right blood goes to the right patient.
• Delayed hemolytic reaction. This kind of reaction usually only happens if a person has had many transfusions in the past. The body slowly attacks proteins on the transfused donor cells. Extra testing can be done to match blood products for these people to prevent future reactions.
• Graft-versus-host disease (GVHD). This only happens in people with a very weak immune system, such as after a bone marrow or organ transplant. In this reaction, the white blood cells of the donor blood attack the tissues of the person getting the blood transfusion. To prevent GVHD, donated blood can be treated with radiation before transfusion (called irradiated blood products).

Some of these reactions can happen during the transfusion, but some might not happen for days after your transfusion. Tell your doctor or nurse right away if you have:

• Itching, hives, or rash
• Swelling in the face, lips, or tongue
• Headache or dizziness
• Fever or chills
• Trouble breathing or new cough
• Chest or back pain

Infections

The chance of getting an infection from a blood transfusion in the United States is very low. All blood donors are screened, and all blood products are tested for the following infections:

• Hepatitis B virus

• Hepatitis C virus
• Human immunodeficiency virus (HIV)
• Syphilis
• HTLV-I and HTLV-II
• West Nile virus
• Chagas disease

Some states require other tests depending on common infections in that area. More tests may be ordered for certain patients. For example, some patients need cytomegalovirus (CMV)-negative blood products.

Bacterial contamination

Rarely, tiny amounts of skin bacteria get into the blood during donation. Platelets have the highest risk of bacterial contamination because they are kept at room temperature. Other blood products are refrigerated or frozen, which lowers the chance of bacteria growing.