• Reference Number: HEY922- 2024
• Departments: Renal Service
• Last Updated: 1 July 2024

Introduction

This leaflet has been produced to give you general information about your treatment. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a blood transfusion?

A blood transfusion is when you are given blood donated by someone else. It is a very safe procedure that can be lifesaving. Blood transfusion is given to treat low red blood cell count, also called anaemia. Kidney disease is an important cause of anaemia.  If the blood count is too low, despite giving you iron replacement and the erythropoietin (EPO) hormone e.g. Aranesp (injection), or HIF inhibitors e.g. Roxadustat (tablet), you may need a blood transfusion. This is given during a haemodialysis session. Some patients may not be suitable for iron, hormone injections or HIF tablets so a blood transfusion may be the only treatment to improve your anaemia.

Why do I need a blood transfusion?

A blood transfusion may be needed if you have a shortage of red blood cells. This is because your body is not making enough red blood cells due to their Chronic Kidney Disease (CKD), End Stage Kidney Disease (ESKD) or on chemotherapy.

You may have symptoms of anaemia which can include tiredness, dizziness, shortage of breath, cold hands or feet, chest pain and lack of concentration.  More than half of patients with ESJKD or CKD are anaemic. If the anaemia is not improved then the body may not have enough oxygen.

What will happen?

The blood will be administered through the dialysis machine whilst you dialyse. You will be monitored by your dialysis nurse before, during and after the transfusion.  Most people do not feel anything unusual during a blood transfusion.

Can there be any complications or risks?

The risk that a blood transfusion will cause severe harm is very low but there is a small risk of complications such as an allergic reaction to the donor blood.

One of the most important checks for a safe transfusion is to make sure you get the right blood and therefore it is important that you are correctly identified at each stage of the transfusion, including when blood samples are taken before the transfusion.

There are different blood groups, which vary from person to person, so a cross-match sample will be taken before the transfusion, to match your blood with a suitable donor unit in the blood bank.

Wearing an identification band with your correct details is essential. You will be asked to state your full name and date of birth and this will be checked against your identification band. It is alright to remind the healthcare professional to ask you for this information. If you have a card that states that you need to have blood of a specific type, please show it as soon as possible to your healthcare professional.

There is a small risk of rare infections (please note the blood before transfusion is screened for some infections like hepatitis, however, it is not possible to screen the blood for all possible infections).

You can refuse to have the transfusion.  If a blood transfusion is recommended, it is important you understand the implications to your health of refusing the transfusion. If you are refusing on religious grounds then speak to your doctor as there may be other options.

What are the signs of a transfusion reaction?

Transfusion reactions describe a rare group of complications following treatment with blood.

The signs and symptoms of possible reactions include:

• A high temperature (especially above 38.5°C) (38.5 degrees Celsius)
• Increased heart rate
• Shivering or cold chills (rigors)
• Breathing problems
• Blood in your urine
• Itchy skin rash or nettle rash (hives/urticaria)
• New swelling or worsened swelling of the legs
• Jaundice (yellow colour of the white of your eyes)
• Passing very dark urine
• Extreme tiredness
• Pain in the lower back
• Unexplained bruising
• Feeling sick
• Feeling anxious

The majority of reactions happen during or immediately after the transfusion, however, transfusion reactions can occur within 24 hours of treatment with blood and delayed transfusion reactions can occur 24 hours after treatment with blood.

To help reduce the risk of fluid overload you may be given diuretics so you do not become fluid overloaded.

The reactions are usually very mild in nature and may cause a few minor problems.  Any unusual or unexpected symptoms occurring within 14 days of your transfusion with blood should be reported to your doctor or nurse.

Severe reactions to blood transfusions are extremely rare but in the event of an emergency once you are home, please dial 999 or go to your nearest Emergency Department (ED).

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Dialysis Unit (01482) 608748 or 608753.

If you need urgent advice out of hours please contact or attend the Emergency Department.