When Your Child Needs a Blood Transfusion

Blood loss can happen if your child has an injury, surgery, or an illness that affects blood cells. Blood is made up of several different parts (blood products). Your child may receive some or all of these blood products through a transfusion. Blood for transfusion is donated from another person (donor). Strict measures are taken to make sure that donated blood is safe before it’s given to your child. Your child’s healthcare provider will discuss your child’s condition with you and answer your questions.

The parts of blood

Blood can be separated into different parts that perform special roles in the body. These parts include:

• Red blood cells, which carry oxygen throughout the body

• Platelets, which help stop bleeding

• Plasma (the liquid part of blood), which carries red blood cells and platelets throughout the body. Plasma also contains proteins like clotting factors that help stop bleeding. 

Are blood transfusions safe?

Donors provide the blood used for transfusions. To make sure that blood is safe:

• The health and medical history of each donor is carefully screened. If a person is considered high-risk for infection or problems, he or she isn’t accepted as a blood donor.

• All donated blood is tested for infections such as hepatitis, syphilis, west Nile virus, human T-lymphotropic virus, bacteria, and HIV (the virus that causes AIDS). If the tested blood is found to be unsafe, it is not used for transfusion and not given to another person. 

• Blood is divided into 4 general types: A, B, AB, and O. Blood also has Rh types: positive (+) and negative (-). Your child must only receive blood products that are compatible with his or her blood type. A sample of your child’s blood is tested for compatibility with donated blood. This is done before blood products are prepared for a transfusion.

How is a blood transfusion done?

A blood transfusion takes place in a blood center, infusion center, hospital room, or operating room. Your child’s healthcare provider will discuss the blood transfusion with you before it’s done. You’ll need to give permission for the blood transfusion by signing a consent form:

• Two healthcare providers confirm your child’s identity. They also confirm that they have the correct blood product(s) for your child.

• An intravenous (IV) line is placed in a vein if your child does not already have an IV. This may cause your child some brief discomfort. Your child may be given medicines before the transfusion to prevent transfusion reactions. 

• The blood product comes in a plastic bag that is hung on an IV pole. The blood product flows from the bag into your child’s IV line. The IV line may be connected to a pump, which controls the transfusion rate. Your child may receive more than one kind of blood product through the IV.

• Your child’s vital signs (blood pressure, heart rate, respiratory rate, and temperature) are checked throughout the transfusion. This is to make sure your child is not having a reaction to the blood product.

• The IV line may be removed once the transfusion is complete.

Possible risks and complications of a blood transfusion

Most transfusions are problem free. In some cases, reactions happen. These can happen within seconds or minutes during the transfusion or a week to a few months after the transfusion. The most common reactions from blood transfusions are mild allergic reaction and fever. Call the healthcare provider right away if your child has any of the following signs and symptoms during or after a transfusion:

Reaction	Timing	Signs and symptoms
Allergic reaction (mild)	Within seconds to minutes during the transfusion Up to 24 hours after the transfusion	Hives or red welts on the skin, mild itching, rash, localized swelling, flushing (red face), wheezing, shortness of breath, or stridor (high-pitched noise or sound)
Anaphylactic reaction (severe allergic reaction)	Within seconds to minutes during the transfusion Up to 24 hours after the transfusion	Shortness of breath, flushing (red face), wheezing, labored (working hard) breathing, low blood pressure, localized swelling, chest tightness, or cramps
Febrile nonhemolytic reaction	Within minutes to hours during the transfusion From a few hours up to 24 hours after the transfusion	Fever, chills, flushing (red face), nausea, headache, minor discomfort, or mild shortness of breath
Acute immune hemolytic reaction	Within minutes during the transfusion Up to 24 hours after the transfusion	Fever, red or brown urine, back pain, fast heart rate (tachycardia), abdominal pain, low blood pressure, feeling anxious, chills, chest pain, nausea, or fainting spells
Transfusion-related acute lung injury (TRALI)	Within 1 to 2 hours during the transfusion Up to 6 hours after the transfusion	Shortness of breath, trouble breathing, low blood pressure, fever, pulmonary edema
Transfusion-associated circulatory overload	Near the end of the transfusion Within 6 hours after the transfusion	Shortness of breath, fast heart rate (tachycardia), problems breathing when lying on back, abnormal blood pressure
Post-transfusion purpura (PUP)	Within 1 week Up to 48 days after the transfusion	Purple spots on skin; nose bleed; bleeding from the urinary tract, abdomen, colon, or rectum; fever; or chills
"Delayed" transfusion-related acute lung injury (TRALI)	Within 72 hours (3 days) after the transfusion	Sudden onset of respiratory distress or trouble breathing
"Delayed" hemolytic reaction	Within 3 to 7 days Up to weeks after the transfusion	Low-grade fever, mild jaundice (yellowing of the skin and whites of the eyes), decrease in hematocrit, chills, chest pain, back pain, nausea