Blood transfusion risk vs benefits??

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Hello, just wanted some advice?been watching This Morning about haemophiliacs infected with HIV from blood transfusions in the 80?s.

What are the risks today? Obviously blood is now screened for Hepatitis and HIV, but what about other blood borne diseases?

I had a blood transfusion following a retained placenta. I tried for a natural third stage but nothing was happening, had the injection and still nothing. Midwives tried cord traction which caused quite a lot of blood loss and I passed a large clot.

I was transferred to hospital (had an amazing home birth and DD was born in a birth pool ) for a manual removal of placenta. I was given 2 units of blood as well as saline, antibiotics and something to make the uterus contract and stem the blood flow.

Apparently I lost 800ml of blood and I did feel quite unwell so I gave my consent for a transfusion without much thought, as I was totally out of it!

Is 800ml a significant amount of blood loss do you think? Its only now I?m wondering if it was really necessary and what risks this may pose to my future health .

What treatment could be given instead of a transfusion?

Also when planning for the next birth will a retained placenta and post partum haemorrhage in my first birth mean it will happen again? Do you think this will be a contraindication to home pool birth next time?

I?m definitely going to have a managed third stage next time to try and avoid retained placenta and will ask to be transferred to hospital for a manual removal sooner, to reduce amount of blood loss caused by traction on the cord.

Any advice would be great, I?m really worrying that I might have put myself at unnecessary risk and want to be better informed for next time!

Don't know why there are question marks instead of apostophes? Sorry!

Thanks KerryMumbles - I didn't know you could bank your own blood, do you have to contact the local hospital or the blood service?

I could do it before I try for DC2, do you think childbirth would equate to planned surgery? Will have to do some further reading...

Risks are you either bleed to death or you end up having a heart attack because you are so anaemic Vs trusting health professionals to use their skills and judgement to try to save you.
You really only get given a transfusion if absolutely necessary.
If you don't trust the system to screen adequately you could look into banking your own, although i don't know how long it lasts for and if you're pregnant i'm not sure it would be wise to part with a few units anyway.

I think it's for you as an individual to weigh up. I had a PPH after dd1 was born - I lost 1000ml and was offered a transfusion, but I said no because I did not feel bad and I didn't think it would be necessary. I have a naturally high HB count though, and even after that it was still measured at 12 the next morning. So I think a hemorrhage is not the same thing for one person that it is for the next.

I don't like to receive blood products easily though and I refused routine anti-d in this pregnancy because of that.

although has to be said i think blood is so utterly revolting i'd have to be near unconscious to agree to be given it.

DisasterArea - that is not true - if I had said yes they would have given me a transfusion without checking my hb count. The next morning they were like 'oh, don't know what we were worried about'

Hi there, I have a fear about transfusions too, which I know is largely irrational but I was bothered enough to make DH promise that if DS required blood after surgery, that he would donate for him! (DH is a universal donor). I have no idea if this would have been practical or not as I am guessing they don't let you whip your arm out there an then in the theatre, but it set my mind at rest a bit.

I'm not sure about the rest of your questions but in terms of the amount of blood you lost, you normally donate about 450-500ml when you go to give blood, which can make you feel a bit light-headed for a while but is not enough to compromise health.

Hope that puts it in some context - 800 ml is obviously quite a bit more, especially following an exertion like childbirth.

Don't worry too much - it's important to remember that the risks from individual blood transfusions are very low, haemophiliacs were being given many many transfusions at a time when screening was much less rigorous than it is now, you had one single transfusion very recently so the risks are tiny. (That's what I tell myself anyway!)

I think you shoudl discuss all this with your GP who will be able to put your worries in better context - and hopefully advise you about Kerrymumbles point about blood banking.

The risk of getting hepatitis from a blood transfusion is currently about 1 in 500,000 for hepatitis B and 1 in 30 million for hepatitis C. The chance of getting HIV or HTLV infection is about 1 in 5 million. Although the risk of getting variant Creutzfeldt-Jakob Disease (vCJD) from a blood transfusion is probably low with a single blood transfusion, the risk of any infection will increase with additional blood transfusions. Each year, approximately 2 million units of blood are transfused in England and there have been just a handful of cases where patients are known to have become infected with vCJD from a blood transfusion.

the risks according to national blood service.

I do wonder if more info should be given before giving of transfusions. I had two when I had the dts. I don't even rem,ember giving my permission or being asked for it. I didn't realise until a lot later that there were risks which means I can't donate blood now. Was rather shocked.

It might help (might not?!) to consider that the risk of dying of a complication due to pregnancy, childbirth or post-partum complications is far, far greater than any of these possibilities (I've read varying estimates but most put it at between 1 in 3500 or 1 in 10,000 in the UK).

So really the transfusion is probably the safest part about having a baby .

(Not trying to belittle your worries btw, as I share them, but putting the statistics in context helps me to worry less).

No, you can't screen for vCJD, but there are currently no known cases of anyone dying from vCJD contracted from a blood transfusion. HCPs are very aware that blood transfusions carry a small risk and will generally only recommend one where they feel that the benefits outweigh these risks.

It may be different at other hospitals, but certainly where I work you cannot bank your own blood for use later.

That is probably part of the reason, but vCJD has been around a fair while now. vCJD is the major reason that recipients of donated blood cannot become donars themselves, as another layer of protection.

Thanks for those stats Chops. I too had a transfusion when DS was born in 2001. I had four units, three days after the birth (which was traumatic) I couldn't stand up without passing out and when they did the blood tests, they were astounded by how low my hg level was. The nurse said it would take months to get it to return to normal levels without a transfusion so I went ahead. I must agree that the risks were not explained, and I too felt so out of it I didn't really think to ask any questions. Having said that I felt instantly better and was able to visit DS in the special baby unit on my own for the first time Certainly nothing abnormal showed up in the blood tests had had for pg2 but I understand that these things can lie dormant for years. I just try not to worry.

Daisy - I've read that the reason they worry about vCJD is because someone did develop vCJD after a blood transfusion from someone who also developed vCJD. Whilst there is no evidence that this was due to the transfusion rather than coincidence, they would rather not take the risk of with those who have had a transfusion donating blood (or breastmilk).

Seeline - Thanks for that as I did wonder what would have happened if I had refused. I would probably still be recovering now so I am glad I did have a transfusion. I agree it is best to try not to worry. Who knows how many risk factors we have all been exposed to over the years that we didn't know about at the time.

Thanks ladies, especially for the stats comparing the risk of bleeding to death v infection, I do find it really difficult to trust HCPs for some reason - suppose I've watched/read too many horror stories about neglegence etc... it does help me to think of what might have happened if I hadn't had the blood. I felt much more 'with it' afterwards although I was aneamic for a few weeks after.

I do think that more infomation hould be given to pregnant women about the possibility of transfusion and the benefits / risks, so that they can mak an infomed choice - as they do with pain relief options

With regards VCJD, I know of a childhood friend who died of this condition...and she gave blood regulalry as an adult. I presume that since this, donated units have been destroyed but it is worrying to think of how many people may have already recieved this blood.

I don't even eat beef so I was rather miffed at the risk of cjd. having said that I think I would have still gone ahead, given how low the risks are.

I would hope that people who donate blood are very concious of thier past health and risks. I give blood but i know that i haven't got anything untoward so i am happy to donate.

Clearly some cases are life threatening so there is no real 'choice' about receiving blood. I was worried that in my case it may not have been really neccessary and that the risks may then have outweighed any possible benefits.

Having said that, it did make me feel much, much better and enabled me to beastfeed, hold and bond with my baby. So in that respect, it was worthwhile. Without it I would have been so weak and poorly I would have found it difficult to care for my DD and get myself well again.

CharleeInChains - The whole blood service relies on selfless people like you to give their blood, I am truly greatful to whoever gave me their blood!

Afterwards, I really wanted to give blood as a kind of payback, but then realised I couldn't - my DH has promised he will give 2 units to replace the 2 I had!

Following a PPH, it was estimated I lost 3 litres of blood. I ended up receiving 6 pints of blood and also fresh frozen plasma. I am so grateful to the people who donated it. Each time blood was given I had to sign to say I understood risks (my partner had to read it and sign for the first unit as I was too ill). In the unlikely event I have contracted something from the blood, at least I am here now raising my son. I don't worry about it - I worried about dying and leaving my 5 day old baby without a mum.

With very limited supplies, I think that they don't give it lightly, and if you are well enough to, you can always discuss having it and the risks of watching and waiting.

I have only done it twice!

it was one of thoses things that i was always getting round to doing then i was walking past a donation center in Sept last year and something compelled me to go in. Shall soon be that time again for another evening of free tea and biscuits!

I don't think it's the case that docs would only ever give you a transfusion if it was necessary.

I had low count after a c-section and they were kind of "you must have lost a lot of blood, do you want a transfusion or shall we just give you iron tablets?". I plumped for the tablets as I was itching to get out of hosp. Definitely felt light-headed and weedy (that might have been the morphine!), but picked up fairly quickly with iron supplements taken with lots of orange juice.

A HV commented later on looking at my notes that I hadn't lost that much blood and wouldn't have needed a transfusion. And my sis, who's a doc, said best to avoid transfusion if you can.

HTH.