Complications of Blood Transfusions: Reactions You Don't Expect!

I'm not one to transfuse blood at the drop of a hat. They are expensive and come with their own complications such as transfusion related lung reactions and exacerbation of heart failure. God forbid you get hepatitis B or C or even HIV from a blood transfusion.  While all blood is screened and contracting a virus from a blood transfusion is uncommon,  no test is 100%.  The threshold for transfusing blood is one area of medicine that is highly individualized among physicians.  Every doctor has their own threshold to transfuse blood.  I don't know why that it.  It shouldn't be like that.  Transfusing blood should be a standardized process, much like the tPA criteria required for stroke patieints.

I use a hemoglobin of seven as my cut off when trying to decide whether to transfusion someone or not because that's what a nearly decade old study suggested was appropriate for critically ill ICU patients. However, if a patient has unstable hemodynamics, my goal is higher.  If a patient is actively bleeding, my goal is higher. I just don't think there is a lot of data to tell docs what those goals should be.

We used to believe that having coronary artery disease was a prerequisite to transfusing to a goal hemoglobin of 10 or higher.  But recent data ( I'm sorry, I can't find the source), suggests that goal is unnecessary.  That makes sense  if you can imagine how many of our chronic renal patients on dialysis have a hemoglobin permanently in the mid eight range  and never have problems with their heart disease.

Sometimes, with regards to the complications of blood transfusions, less is more.  The other day I tried to explain the risks of giving blood to an 88 year old woman admitted with cellulitis.

Happy:  After this blood starts Mrs Smith, if you notice fangs starting to grow, you need to let the nurses know.  You might be turning into a Vampire

Mrs Smith:  wide eyed and frozen with fear.

Daughter:  yelling at mom.  Mom! Mom! Mom!  He's just kidding.  You're not going to turn into a Vampire.

That's not exactly the transfusion reaction I was expecting.  This old lady someecard helps to explain: