The purpose of this brochure is to give you information about blood transfusions (say: trans-FYOO-shun) and blood products and answers some of the questions parents often ask.
What is a blood transfusion?
When your child has a blood transfusion, they are given a blood product to supply the part or parts of blood that they do not have.
What are blood products?
Blood products are made from the blood of people who give (donate) their blood. These people are called blood donors.
The blood donated by a donor is called whole blood. Whole blood is made up of red blood cells, white blood cells, and platelets, all mixed with a pale yellow liquid called plasma.
Special processes are used to separate whole blood into its different parts. These parts are called blood products.
The different types of blood products and their uses are described later in this brochure. Please read about the blood product your child is getting.
Types of blood products
There are many types of blood products. The components that can be made from blood are:
Plasma may also be made into special products, such as:
These products are called plasma protein products. You can read more about these plasma protein products below.
Why blood products are used for a blood transfusion and not whole blood
Each part of the blood has a different function. Separating the blood into parts lets patients get only the specific part or parts of the blood that they need. So a whole blood donation can be used for several patients.
Red blood cells
Transfusions of red blood cells are given to increase the oxygen supply to the body after a loss of blood. Your child may have lost blood because of a surgery, accident, or bleeding.
Transfusions of red blood cells are also used to treat certain types of anaemia. Anaemia means your child does not have enough red blood cells. For example, your child may have had anaemia since birth. Or your child may have anaemia because of a long or serious illness or treatment for cancer.
Platelets and plasma
Transfusions of platelets and plasma are used to stop or prevent bleeding. For example, your child may have bleeding because of surgery or treatment for cancer. Your child will only get the specific part or parts of the blood needed for the treatment because each blood product has a different function.
Where the blood comes from
Canadian Blood Services (CBS) collects blood from volunteers. Volunteers are people who donate their blood for free. These volunteers answer a long questionnaire and have an interview and a physical exam or check-up to make sure that they are healthy before they are allowed to donate blood.
These blood donations supply red blood cells, plasma, cryoprecipitate, platelets, and most plasma protein products. But some plasma protein products also come from the United States and other countries because Canadians use more plasma protein products than can be made from the blood collected in Canada.
How the blood is tested and treated
Each blood donation is tested for for the blood group of the donor, for example ABO group and Rh factor. This is to ensure that recipients receive compatible blood (blood that matches their blood type).
Donor blood is also tested for infectious diseases. Infectious diseases are diseases that can be spread from one person to another. All blood that is donated is tested for the infectious diseases listed below:
syphilis, an infection that a person can get from sexual contact
hepatitis B and hepatitis C, which are infections of the liver
human T-cell lymphotropic virus type 1 (HTLV-I), which causes a rare form of leukemia or cancer of the blood
HIV 1 and HIV 2: human immunodeficiency viruses that cause AIDS
West Nile virus
Any donated blood that does not pass the tests for these infections is not used for transfusion.
Plasma protein products go through extra testing and treatment
Plasma protein products from donated blood are tested and also treated with heat or chemicals to kill viruses such as the AIDS, hepatitis B, and hepatitis C viruses. A virus is a kind of germ that causes disease. This treatment is always done just in case the testing may have missed any viruses.
For more information about blood products, please go to the Canadian Blood Services site at blood.ca.
Blood transfusion reactions
Some patients have mild reactions to a blood transfusion, such as having a skin rash or a fever, or feeling cold. A patient may have a hemolytic transfusion reaction. This happens when the red blood cells in the blood transfusion break up. Hemolytic transfusion reactions are very rare and can be a serious problem. Your child will be watched closely during the blood transfusion.
Plasma protein products do not cause hemolytic transfusion reactions. But plasma protein products may cause allergic reactions. Some of the signs of an allergic reaction are:
Most patients do not react to a blood transfusion. But if your child has a reaction, please tell your child's nurse right away.
Risks of a blood transfusion
The safety standards for the blood supply are very high. But there is still a very small chance of getting a disease or injury from donated blood.
Donated blood can sometimes cause breathing problems and injure the lungs. This is called TRALI (transfusion-related acute lung injury). For every 5,000 units of blood transfused, 1 person will have this problem.
Bacteria from the donor's skin can sometimes enter the blood bag and infect the donated blood while it is being collected. This can cause an infection when someone receives the blood. For every 10,000 units of blood transfused, 1 person will have this problem.
If a blood recipient has a weakened immune system and receives a transfusion, the white blood cells from the donor can sometimes try to take over the recipient's bone marrow. The new marrow can then attack the recipient's body. This condition is called transfusion-associated graft versus host disease (TAGVHD). It is very dangerous but very rare. For patients with a known weakened immune system, including children with cancer and babies, the blood transfusion lab will treat (irradiate) the donor blood to kill the white blood cells and prevent this problem.
In Canada, because blood donors are screened and blood is tested, the chance of getting a unit of blood with a virus in it is very small.
The chance of getting HIV (AIDS) is less than 1 in 10 million.
The chance of getting hepatitis C is less than 1 in 3 million.
There is also a very small chance of getting hepatitis B, HTLV, malaria, West Nile virus, and other rare infections.
Plasma protein products have been treated to kill viruses, so they do not spread these infections.
Like any medical treatment, a blood transfusion has some risks. But when your child needs blood as part of treatment, the benefits should be greater than the risks.
Talk to your child's doctor before you decide if your child should have a blood transfusion. Then compare the risks of your child having a blood transfusion with the risks of your child not having a blood transfusion.
What happens if your child needs a blood transfusion
Your child's doctor will explain to you why your child needs a blood transfusion, what the benefits and risks of the blood transfusion are, and if there are any other treatments your child could have instead of a blood transfusion.
If you agree that your child should have a blood transfusion, your child's doctor will ask the Blood Transfusion Lab for the blood product your child needs. The Blood Transfusion Lab will then prepare that blood product.
You will be told if your child has had a blood transfusion
You will be told if your child has a blood transfusion. Your child's hospital record will have information about your child's blood transfusion. If this is your child's first blood transfusion, you will get a transfusion card that lists your child's name, hospital number, blood group, and the date of the blood transfusion. This is part of your child's medical record that you should keep always.
Alternatives to transfusion
Because every blood product has a specific function, there may not be another treatment your child can have instead of a blood transfusion. Instead of a transfusion of blood from volunteers, in some cases, your child may be able to have one or more of the following:
An autologous blood donation
Your child may be able to donate blood for herself if she is having a surgery that is not an emergency and that is likely to cause a large loss of blood. This type of blood donation is called an autologous blood donation. Your child's doctor can arrange for this type of blood donation.
Haemodilution involves taking some of your child's blood and storing it just before a surgery. Then your child gets liquids such as salt water through a tube in a vein. These liquids replace the blood that was taken to keep the volume, or amount, of blood the same. The blood that was taken may then be given back to your child after the surgery if she needs a transfusion of red blood cells.
When the doctors think that your child's surgery may cause a large loss of blood, they may collect some of the blood that your child loses. They may give that blood back to your child in a blood transfusion during or after the surgery.
Your child may have this type of blood transfusion if she is having a surgery on the heart or bones. But this type of blood transfusion is not done for surgeries on the bowels because the blood may have bacteria or germs that cause infections.
There are a number of medicines that may reduce your child's need for blood transfusions during a surgery:
Some medicines lower your child's blood pressure. Blood pressure measures how strongly the heart pushes blood around the body. The use of these medicines will depend on your child's condition and the type of surgery.
Some medicines reduce the amount of bleeding by forming clumps of blood, called blood clots, or by slowing the breakdown of the blood clots that are formed. The use of these medicines will depend on your child's condition and the type of surgery.
A medicine called erythropoietin may be used before elective surgery to reduce the need for red blood cells during the surgery. Elective surgery is a surgery for a condition that is not an emergency. Erythropoietin causes the body to make more red blood cells. Iron is also needed to make haemoglobin, the part of the blood that carries oxygen. If your child is given erythropoietin, she will get it by needle once or twice a week for about 4 weeks before the surgery. Your child will take iron pills at the same time.
Artificial blood is not for general use at this time
Salt water (saline) and liquids that have a thickener like starch in them may be used at first to replace the blood that your child has lost. But they are not enough if your child has lost a large amount of blood.
There is no artificial blood, or blood made in the laboratory, that does all the things that blood does. Substitutes for red blood cells that can carry oxygen are being made in the laboratory. But they are still experimental and are not for general use in Canada at this time.
Directed blood donation
You may donate blood for your child's use if your blood group matches your child's blood group and if your child:
is having a surgery that is not an emergency
is very likely to need blood
is too small for an autologous blood donation
needs red blood cells to treat anaemia (for example, if your baby was born early)
This type of donation of blood for a specific patient is called a directed blood donation. Many people feel more comfortable knowing who the blood donor is. But no medical study has shown that directed blood donations are safer than the blood collected from regular blood donors. Canadian Blood Services (CBS) allows directed donations only from a parent or legal guardian to their minor child.
For more information
You can get the booklets described in this document from the doctor who treated your child or from the nurses who work with your child's doctor in the unit or the clinic.
Talk to your child's doctor about any specific questions you have about your child's care and need for a blood transfusion.
This section describes some of the blood products that your child may get from the Blood Transfusion Lab and what they are used for.
There are 2 main types of blood products:
plasma protein products
Blood components are made from the blood of a single donor. Plasma protein products are made from the blood of many donors.
Whole blood is the blood donated by a blood donor. Whole blood is made up of red blood cells, white blood cells, and platelets, which are cells mixed with a pale yellow liquid called plasma.
Blood components are blood products that are made from the whole blood of a single donor. Three of these blood components may be made from one unit of donated whole blood:
red blood cells
Red blood cells
Red blood cells are used to increase the amount of oxygen in the body. Red blood cells carry oxygen in the blood to all parts of the body. Your child may get a transfusion of red blood cells if she has lost blood or has anaemia. People who have anaemia do not have enough red blood cells.
Platelets help the blood to clump (clot) by sticking to blood vessels that have been cut. Your child may bleed and need a platelet transfusion if she has a low number of platelets or if she has platelets that are not working properly.
Plasma is the liquid part of the blood that has proteins such as clotting factors in it. Clotting factors cause the blood to clump and stop flowing out of blood vessels that have been cut.
Frozen plasma and cryoprecipitate
Frozen plasma and cryoprecipitate are made from plasma. They are used to treat patients who do not have enough clotting factors in their blood.
Frozen plasma has all the clotting factors.
Cryoprecipitate is made from frozen plasma and has mainly fibrinogen, Factor VIII, and von Willebrand Factor. Fibrinogen and Factor VIII help to make the blood clot. Von Willebrand Factor helps platelets stick to blood vessels that have been cut. There are now plasma protein products for Factor VIII and von Willebrand Factor. The main use for cryoprecipitate is fibrinogen replacement.
Plasma protein products
Plasma protein products are blood products that are made from the plasma taken from the blood of many donors. The plasma is mixed and then separated into different parts. This process of separation is called protein fractionation.
Plasma protein products are treated with heat or chemicals to kill viruses in the blood that cause diseases such as AIDS, hepatitis B, and hepatitis C. Hepatitis B and hepatitis C cause liver disease. Malaria and West Nile virus are also killed by the treatment.
There are 3 main types of plasma protein products your child may get:
clotting factor concentrates
Albumin expands the volume of the blood. Your child may get a transfusion of albumin if your child:
has lost blood
has a very low blood pressure
had surgery on her heart
needs to have a plasma exchange; in a plasma exchange, plasma that is not healthy is removed and replaced with healthy plasma or albumin
Factor concentrates are used to prevent or control bleeding. If your child does not have enough clotting factors in the blood, she may get a transfusion of factor concentrates. This is a list of factor concentrates your child may get:
Immune globulins contain antibodies which are used to fight infections. Your child may be given these immune globulins by a needle into a muscle:
Your child may be given these immune globulins by a needle into a vein:
Immune serum globulin is given to stop a person from getting hepatitis A and measles for a short time. Hepatitis A is an infection of the liver. Measles is an infection that causes red spots on the skin. Measles is not commonly seen now because most children have had a vaccine or shot to protect them from getting measles. Immune serum globulin is also given to persons who do not make enough antibodies of their own.
Varicella-zoster immune globulin is used to prevent chickenpox or make it less severe after contact with someone who has chickenpox. Chickenpox causes a rash and blisters on the skin in healthy children. But chickenpox may be severe in someone who has a weakened immune system (someone whose ability to fight infection is weak).
Hepatitis B immune globulin is used to prevent infection with the hepatitis B virus or make the infection less severe after contact with someone with the hepatitis B virus. Hepatitis B is an infection of the liver.
Tetanus immune globulin is used to prevent tetanus or make it less severe. Tetanus is a disease that causes muscles to cramp and get tight and stiff. It may be severe enough to cause death in some cases.
Intravenous gamma globulin is used to treat people who do not have enough antibodies to fight infection. Intravenous gamma globulins are also used to treat certain diseases caused by antibodies such as idiopathic thrombocytopenic purpura, which is also called ITP, and Kawasaki disease.
People with ITP make antibodies that destroy their own platelets. Treatment with gamma globulin slows this process.
Kawasaki disease is a childhood illness. People with Kawasaki disease have a fever, a rash, and swollen glands in the neck. Treatment with gamma globulin prevents the damage to the heart that Kawasaki disease sometimes causes.
Cytomegalovirus immune globulin is used to prevent or to treat an infection caused by a virus called cytomegalovirus or CMV. Cytomegalovirus does not cause disease in healthy people, but may make people with weakened immune systems (people whose ability to fight infection is weak) very sick.
Rh immune globulin is used to prevent people who are Rh negative from making Rh antibodies when they come in contact with Rh positive blood. For example, this contact can happen during pregnancy or a blood transfusion.
A few people are Rh negative. That means that they do not have the Rhesus factor, called the Rh factor, in their red blood cells that most people have. Those people who have the Rh factor are called Rh positive.
Rh immune globulin may be used to increase the number of platelets in children who are Rh positive and have idiopathic thrombocytopenic purpura (ITP). People with ITP make antibodies that destroy their own platelets.
Rh immune globulin may also be given to children who are Rh negative to prevent them from forming Rh antibodies after they have had a blood transfusion with blood that is Rh positive.
For more information
Talk to your child's doctor about any specific questions you have about your child's care and need for a blood transfusion. Please call the transfusion resource nurse if you have questions about the autologous and directed blood donation programs.
Blood transfusions are given to patients to provide them with a blood product to supply the part or parts of blood that they do not have.
Blood products are made from the blood of people who give (donate) their blood.
There are many types of blood products. The components that can be made from blood are red blood cells, platelets, plasma, and cryoprecipitate.
When your child needs blood as part of her treatment, the benefits should be greater than the risks.