Receiving a Blood Transfusion During Cancer: What to Know and What to Expect

October 19, 2023
Richard A. Larson, MD

Richard A. Larson, MD, is a professor of medicine in the Section of Hematology/Oncology and director of the Hematologic Malignancies Clinical Research Program at the University of Chicago. He received his medical degree from the Stanford University School of Medicine and completed his postdoctoral training in Internal Medicine, Hematology, and Medical Oncology at the University of Chicago. Dr. Larson is also a member of the 2023 Cancer.Net Editorial Board. View Dr. Larson’s disclosures.

A blood transfusion is a medical procedure to give blood, or parts of the blood, to someone who needs it. Some people may need a blood transfusion if they have a medical condition, such as cancer, that affects how the body produces blood cells. They may also require a blood transfusion if they lose blood after surgery or are experiencing other causes of bleeding.

Here, learn more about why you might receive a blood transfusion during cancer, what to expect during a blood transfusion, and what to know about the side effects you may experience after receiving a transfusion.

Why might someone with cancer need a blood transfusion?

People with cancer may require a blood transfusion for various reasons, depending on their specific condition and treatment. These reasons might include:

  1. Chemotherapy-induced anemia. Chemotherapy can suppress the bone marrow's ability to produce red blood cells, leading to anemia. Anemia is when you have a low level of red blood cells in your body. Blood transfusions replenish the red blood cell count and can relieve symptoms such as fatigue, weakness, and shortness of breath.

  2. Surgery-related blood loss. Cancer surgery can cause bleeding, and if the patient's blood volume drops too low, a blood transfusion may be needed to restore it to a safe level.

  3. Bone marrow failure and thrombocytopenia (low platelet count). Certain cancers, such as leukemia or myeloma, predominantly affect the bone marrow and interfere with the production of normal blood cells. This is called “pancytopenia.” These diseases, as well as chemotherapy, can interfere with the normal production and function of platelets, which help the blood to clot. Platelet transfusions can help prevent or control bleeding episodes in these patients.

  4. Support during a bone marrow transplant. Before a bone marrow transplant, a person typically received high-dose chemotherapy and/or radiation therapy, which can damage the bone marrow and reduce its ability to produce blood cells. Then, during a bone marrow transplant, the diseased bone marrow is replaced by healthy stem cells from the donor. Blood transfusions may be necessary during this period to support the patient until the transplanted stem cells begin to function and produce new blood cells.

What are the different types of blood transfusions?

Blood is made up of different parts, or components. These components include the liquid plasma, red blood cells, white blood cells, and platelets. Transfusion of whole blood is less common than transfusion of one of the blood components. For most types of blood transfusions, the blood used comes from a donor. Special measures are used to ensure that blood donation is safe for both recipients and donors.

The different types of blood transfusion that your doctor may recommend during cancer and its treatment include:

Plasma transfusion

Plasma is the liquid part of blood that carries the blood cells. It contains proteins that help the blood clot. It can be frozen and stored. A plasma transfusion can be given to people who have bleeding disorders, certain types of cancer, or liver disease. It may also be given after surgery if the person had considerable blood loss.

Red blood cell transfusion

Red blood cells are made in the bone marrow and carry oxygen to the tissues in the body. Red blood cells contain hemoglobin, which is a protein that carries oxygen and gives blood its red color. Bleeding that is caused by trauma, surgery, or certain diseases may lead to a low red blood cell count. If a person has a low red blood cell count, a red blood cell transfusion may be needed. A red blood cell transfusion is usually given when a person’s red blood cell count or hemoglobin level drops low enough to cause symptoms such as dizziness, fatigue, or shortness of breath.

Platelet transfusion

A low platelet count is called thrombocytopenia. A platelet transfusion may be needed if the bone marrow cannot make enough platelets, which may occur during cancer or its treatment. There is a risk of spontaneous bleeding if a person’s platelet count falls too low. Platelets may be given in advance if there is an increased risk of bleeding from a surgical procedure. Sometimes, platelet transfusions are not needed despite a low platelet count if there are no signs of bleeding.

White blood cell or granulocyte transfusion

White blood cells help the body fight infection. Granulocyte transfusions are rarely given. They are usually reserved for people who have a very low white blood cell count, called leukopenia or neutropenia, as well as for people who have a severe infection that doesn’t respond to antibiotics. Instead of transfusing white blood cells, doctors commonly give injections of white blood cell growth factors that stimulate the body to make its own white blood cells.

Autologous blood donation

In some cases, a person can serve as their own blood donor. When someone donates their blood for their own use, it is called an “autologous blood donation” or “autotransfusion.” People may donate their own blood before undergoing surgery in case they need a blood transfusion during or after the procedure. Generally, blood can be stored for up to 42 days.

How is the blood prepared for transfusion?

Blood products that are used in transfusions are treated in special ways to make them safe and to prevent reactions in the recipient. Blood products may be treated with radiation before they are transfused. Radiation doesn’t affect red blood cells or platelets, but it stops white blood cells from functioning. Special blood filters may also be used that help remove white blood cells. This process is called “leukocyte reduction,” and it is used to help prevent a reaction in blood transfusion recipients.

What should I expect during a blood transfusion?

If your doctor has recommended that you receive a blood transfusion, you will have a blood test to find out your blood type and Rhesus (Rh) factor. There are 4 blood types: A, B, AB, or O. The Rh factor is an antigen that is found on the surface of some red blood cells, making the cells “Rh-positive.” This information is important to know so that you receive blood from a donor who matches your blood type and Rh factor.

The blood bank takes important precautions to prevent the recipient from having a reaction to the donated blood. They cross-match the donor’s blood to check that it matches and is compatible with the recipient’s blood type. The health care team also carefully checks the donated blood to make sure the right type of blood is given to the right person. Before a transfusion, you may be given acetaminophen or antihistamines, such as diphenhydramine, to help prevent mild reactions.

During a blood transfusion, an intravenous (IV) needle is inserted into a vein in your hand or arm. A bag of specially selected and matched blood cells is hung on a pole, and the blood flows from the bag through the IV and into your vein. Most of the time, people don’t feel any discomfort when the blood goes in. However, the blood is refrigerated, so it may feel a little cold.

During the transfusion, the nurse will monitor your temperature, blood pressure, and heart rate. The nurse will also watch for any rash or signs of an allergic reaction. A red blood cell transfusion usually takes between 2 and 3 hours. Platelet transfusions are shorter.

What are the possible side effects of a blood transfusion?

A blood transfusion is typically a very safe procedure, and the benefits of receiving a transfusion typically outweigh the possible risks. Adults or children who have received several blood transfusions may have a higher risk of reacting to later blood transfusions.

The health care team will watch you closely during a blood transfusion to monitor for possible side effects. Although uncommon, some side effects that may occur during or after a blood transfusion include:

  • Fever, chills, headache, or nausea. These symptoms can be caused by a reaction between the recipient’s immune system and the cells or proteins from the donated blood. When this happens, the nurse may stop the transfusion and give a fever-reducing medicine. When the person’s temperature is back to normal, the transfusion can usually continue.

  • Allergic reaction. An allergic reaction can occur if the recipient’s immune system reacts to proteins in the donated blood. These reactions may include hives or itching. In rare cases, a blood transfusion can cause anaphylaxis, which is a severe and sometimes life-threatening allergic reaction. If an allergic reaction occurs, the transfusion is stopped and allergy medicines such as antihistamines and steroids are given. If the reaction is mild, the transfusion can start again. If the reaction is more serious, the transfusion is stopped.

  • Hemolytic reaction. This type of reaction is very rare but can occur when the donor’s and recipient’s blood types do not match. During a hemolytic reaction, the recipient’s antibodies attack the transfused red blood cells, causing them to break down, or hemolyze. The recipient develops fever, chills, or chest and lower back pain. This reaction can be mild or more severe. If severe, a hemolytic reaction can result in kidney damage or even death.

  • Transfusion-related acute lung injury (TRALI). This is a reaction of the recipient’s immune system to substances in the transfused blood. TRALI damages lung tissue and causes fluid to accumulate in the lungs. TRALI may be immediate or delayed and causes difficulty breathing. Treatment for TRALI may include being given oxygen.

  • Circulatory overload. This occurs when the recipient’s circulatory system has too much blood volume in it, which can cause difficulty breathing and heart failure. Circulatory overload is more likely to occur in older individuals and those with long-standing anemia or heart problems. It is treated by stopping the transfusion, giving oxygen, and using a diuretic medicine to increase urination and lower the plasma volume.

  • Iron overload. Iron is present in red blood cells and can build up after multiple blood transfusions are given. Too much iron can damage the heart, liver, and other organs. Iron overload is usually treated with a chelating agent that binds to excess iron, causing it to be eliminated through the urine.

  • Infectious disease. The blood you will receive during a transfusion is extremely safe because the blood is tested for infectious organisms, and potential donors are carefully screened. However, there is a very small chance that an infectious disease may be transmitted through a blood transfusion. Hepatitis virus and cytomegalovirus (CMV) are 2 viruses that can be transmitted through blood transfusion. The human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS), can also be transmitted through blood.

Be sure to talk with your health care team if you have any questions or concerns about the blood you will be receiving during your transfusion, how the blood was tested and prepared, and what side effects might be possible after receiving a transfusion.

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