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 previously transfused or pregnant patients. The reaction is generally not severe and is easily treated.

Patients with a history of severe fever reactions should inform their physician prior to 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 by 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 have undergone a screening process to become eligible to donate. Only blood 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 or heart.

Transfusion may be necessary to prevent serious injury, permanent handicap or death. Your physician, surgeon or anesthesiologist will recommend 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 the levels of iron in your body are low, you may experience symptoms such as:

• Feeling tired
• Lack of energy
• Pale skin
• Problem with concentration
• Irritability
• Difficulty breathing

Why you need a lot of iron before surgery

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

A higher red blood cell count facilitates better oxygen delivery to body cells and help you recover faster from your surgery.

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

Iron-rich food  

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

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

These include fruits (strawberries, kiwi, oranges, raspberries), fruit juices, cauliflower, broccoli, brussels sprouts, tomatoes, turnip and foods containing heme iron.

Eating these foods with non-heme iron-containing food will help with the absorption of  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 drinking tea, coffee, caffeinated soft drinks, cocoa and milk (which contains calcium) with your meals. These drinks can lower the amount of iron that is absorbed. Instead, consider having these drinks in between meals.

Please visit Canada 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. It 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 transfusion using donor blood 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 breastfeeding.

Potential side effects

The most common side effects are as follows:

• Flu-like symptoms such as dizziness, drowsiness, fever, headache, muscle and joint pain and weakness
• Redness, burning and pain at the site of the injection
• 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 poorly formed blood cell that do not work like a normal red blood cell) or aplastic anemia
• Changes in blood tests
• 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 rapidly. 

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 allergy:

• Difficulty breathing
• Itching, 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 method for you to receive this medication.

Before taking TXA, tell your physician and pharmacist:  

• If you are allergic to any ingredients 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 these, please stop taking TXA and call your physician immediately or seek emergency treatment:

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