Patient Blood Management

Blood transfusions

Risks

Allergic reactions

Mild allergic reactions, such as hives or itchiness, may occur in about one in 300 cases. These reactions are easily treated. Severe allergic reactions are extremely rare.

Fever reactions

There is a one in 100 chance of developing fever after a blood transfusion. This is more common in patients who have been transfused previously and in pregnant patients. The reaction is generally not severe and is easily treated.

Patients with a history of severe fever reactions should inform their physician before treatment.

Hemolytic reactions

In rare cases, the patient's blood destroys the donor red blood cells. This is called hemolysis. The chance of an acute hemolytic reaction is one in 25,000.

This can be severe, and lead to bleeding and kidney failure. However, complications can usually be prevented with medical treatment.

Transmissible infections

The risk of chronic infection, injury or death from transfusion-transmitted infections is very small, but cannot be completely eliminated by available testing.

All volunteer-donor blood is screened for infectious diseases, including hepatitis, HIV or the AIDS virus, and other infectious agents. In addition, blood donors undergo a screening process to become eligible to donate. Only blood that tests negative for infectious agents is used.

Risks of not having a blood transfusion

When your body loses too many red blood cells, it cannot get enough oxygen. You run the risk of damaging vital organs such as the brain and heart.

Transfusion may be necessary to prevent serious injury, permanent disability or death. Your physician, surgeon or anesthesiologist will recommend a transfusion based on your individual needs.

Diet and iron

Iron is a mineral essential for making red blood cells, which carry oxygen throughout the body. Adequate oxygen levels are essential for your body's cells to grow and function.

If your iron levels are low, you may experience symptoms such as:

• Feeling tired
• Lack of energy
• Pale skin
• Problems with concentration
• Irritability
• Shortness of breath

Why you need more iron before surgery

Your body needs iron to help build new red blood cells.

A higher red blood cell count improves oxygen delivery to body cells and helps you recover faster after surgery.

Iron ensures you have a sufficient reserve of red blood cells in case of bleeding during or after surgery.

Iron-rich foods

Iron can be found in a variety of foods. There are two types of iron in foods: heme and non-heme iron. All the foods listed below contain iron.

Heme iron is easily absorbed and can be found in foods such as organ meats (liver, kidney, heart), beef, lamb, pork, veal, dark poultry meat, and fish or seafood.

Non-heme iron is less easily absorbed. It is found in whole-grain cereals or fortified cereals; vegetables (beans, lentils, dried peas, chard); dried fruits (raisins, apricots); seeds; nuts; and whole-grain or enriched breads and pasta.

How to get the most iron from food

To enhance non-heme iron absorption, include foods containing vitamin C at the same meal.

These include fruits (strawberries, kiwi, oranges, raspberries), fruit juice, cauliflower, broccoli, Brussels sprouts, tomatoes, turnips, and foods containing heme iron.

Eating these foods with non-heme iron foods will help your body absorb more iron.

Some combinations include:

• Iron-fortified cereal with orange juice
• Whole-grain toast and strawberries
• Egg salad and fruit
• Beef with beans

To optimize iron absorption, avoid tea, coffee, caffeinated soft drinks, cocoa and milk (which contains calcium) with meals. These drinks can lower the amount of iron that your body absorbs. Instead, have them between meals.

Please see Canada's Food Guide for more tips and information.

Erythropoietin

Erythropoietin is a protein that controls the production of red blood cells.

Erythropoietin injections are used to boost the production of red blood cells. They may be given to adults with kidney disease and patients undergoing elective surgery.

While erythropoietin can reduce the need for a blood transfusion from another person, you may still need a donor blood transfusion if you lose a lot of blood during or after surgery.

Before taking erythropoietin

Avoid erythropoietin if you are allergic to any of its ingredients.

Tell your physician about any medical problems, allergies or medications you are taking (including prescription, non-prescription and herbal).

Let your physician know if you have any history of high blood pressure, seizures, blood clots, liver disease, porphyria or gout.

Let your physician know if you are pregnant, trying to get pregnant or breast/chestfeeding.

Potential side effects

The most common side effects are:

• Flu-like symptoms such as dizziness, drowsiness, fever, headache, muscle and joint pain, and weakness
• Redness, burning and pain at the injection site
• Gastrointestinal symptoms such as nausea, vomiting and diarrhea

The following side effects are more often associated with kidney disease:

• Increased blood pressure
• Clotting of hemodialysis equipment
• Pure red cell aplasia (a condition in which are not formed properly), or aplastic anemia
• Changes in blood test results
• Seizures

Potential serious side effects

A more serious side effect of erythropoietin may be high blood pressure. This can happen if your body produces red blood cells too quickly. 

If you develop high blood pressure, your physician may need to reduce or withhold your dose of erythropoietin and start or increase blood pressure medication.

Contact your health-care provider and seek immediate medical attention if you develop the following signs of an allergic reaction:

• Difficulty breathing
• Itching or rash
• Swelling of the throat, face, eyelids, mouth or tongue

Tranexamic acid (TXA)

Tranexamic acid (TXA) is a medication that helps with blood clotting. TXA is used to treat bleeding, including vaginal and in-operative bleeding and works to prevent unnecessary blood transfusions.

It can be taken orally, intravenously and topically. Your physician will discuss with you the most appropriate way for you to receive this medication.

Before taking TXA, tell your physician and pharmacist:

• If you are allergic to any ingredient in TXA
• If you are taking hormonal contraceptives (birth control pills, patches, rings or injections)
• If you have a history of blood clots; a blood clotting condition; or if you have been told you are at risk of developing a blood clot
• If you have, or have, had kidney disease
• If you are pregnant or planning a pregnancy

Potential side effects of TXA

The most common side effects are:

• Headache
• Tiredness
• Sinus, back or stomach pain
• Bone, joint or muscle pain

Potential serious side effects

If you experience any of the following, please stop taking TXA and call your physician immediately, or seek emergency care:

• Hives, rash or itching
• Difficulty breathing or swallowing
• Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles or lower legs
• Hoarseness
• Changes in vision, including colour vision
• Chest pain
• Shortness of breath
• Leg pain, swelling, tenderness, redness or warmth