Refreshed July 30, 2009
Patients with severe and chronic anemia, complicated or rare diseases often need blood transfusions to survive. The patient receiving the transfusion may receive whole blood or parts of blood such as red blood cells (erythrocyte), platelets (thrombocytes)or plasma.
Each unit of whole blood contains approximately 250 milligrams of iron. People who receive frequent blood transfusions should know about iron overload and the therapies that address this life-threatening health issue.
Blood Transfusion Described:
When a patient experiences a drop in red blood cells and cannot replace these cells normally or quickly enough, the physician will likely choose blood transfusion as part of the patient’s therapy. Depending upon the underlying cause, the patient may only receive a few blood transfusions, such as for acute blood loss or surgery. Or the patient may require repeated transfusion as the only means of prolonging or saving the patient’s life, such as to treat thalassemia, sickle cell anemia, some forms of hemolytic anemia, some cancers, bone marrow failure, myelodysplasia, or some forms of leukemia.
A blood transfusion is generally administered in a hospital or infusion center as an outpatient. Prior to the transfusion some basic labwork will be needed to determine a person’s hemoglobin/hematocrit and blood type. A physical exam will be performed, which includes checking a person’s temperature, pulse, respirations, and blood pressure. The infusion procedure requires inserting a needle into a vein in the hand or arm. The needle is connected to sterile plastic tubing, which is attached to the blood product. During the transfusion, temperature and pulse are checked periodically to assure the patient is tolerating the procedure. A transfusion can take about thirty to forty minutes per unit of blood transfused.
For sickle cell disease patients with anemia, the units of blood that are to be transfused must be checked for the anti-antibody to sickle cell disease (SCD). This process is very time consuming and expensive and requires advance notice of the need for transfusion for an SCD patient.
Each unit of blood contains about 500 cc, which is about two cups, and is comprised of red blood cells, white blood cells, platelets, nutrients, water and about 250 milligrams of iron.
Blood used in transfusions is obtained from volunteer blood donors. Some donations are autologous, which means that the blood donor and transfusion recipient are the same. The purpose of autologous donation is for patients who are having surgery where they are transfused with their own blood. Allogeneic blood donation is where the donor and the transfusion recipient are different. This type of donation represents the major portion of the blood supply
Blood is collected at centers such as members of the Red Cross, members of the American Blood Centers (ABC), private blood centers, or hospitals. The Red Cross supplies approximately 43 percent of the nation’s blood supply. ABC members supply about 50 percent and the balance is supplied by private centers or hospitals. Blood collection centers depend upon altruistic donors for their supply of blood.
In April of 1999, the FDA approved the use of blood taken from people with hemochromatosis safe for transfusion. Blood centers could apply for an FDA variance to use HHC blood for transfusional purposes. Variances are required for several reasons, but most notably, patients with hemochromatosis can give blood more often than other donors. To prevent anemia, regular blood donors cannot give blood more frequently than every 8 weeks. This allows time for red blood cells to be replenished. Some HHC patients can donate up to twice a week without becoming anemic. Once excessive body iron stores are reduced to normal levels, donation frequency is reduced to several times a year to maintain healthy iron levels. Blood from HHC donors adds significant resources to the nation’s blood supply.
A common misconception is that the blood from hemochromatosis donors contains excessive amounts of iron. In fact, the blood from hemochromatosis donors contains the same amount of iron as other donors. HHC blood has a unique advantage over other blood. Because this blood is taken more frequently, it contains more young red blood cells, which is a benefit to the recipient. HHC blood is checked in exactly the same way as all other blood donated. Centers that provide hemochromatosis donor programs report that the units of blood obtained from HHC patients are discarded at the same rate as non-HHC units of blood. This means that there is no greater risk associated with HHC blood.
Hemochromatosis is an inherited disorder of iron metabolism. It is not a blood disease. People with hemochromatosis absorb as much as four times the amount of dietary iron as do people with normal iron metabolism. Excess iron is stored in ferritin, an iron-containing protein, which is in every organ of the body. When a person with HHC donates blood, iron is released from ferritin to make new red blood cells.
Numerous private blood centers and hospitals throughout the U.S. have obtained approval from the FDA to accept such frequent donations from hemochromatosis patients for use in blood transfusions. In 2008, the FDA asked the public for comments on proposed changes in the variance application process. Iron Disorders Institute submitted a proposed change that would allow any center equipped to manage the frequency of HHC blood donations either by routine donation or apheresis, to implement an HHC program without obtaining one or more special variances. These centers of course would continue to generate safety reports. If the FDA enacts these changes, all licensed blood centers will be able to accept and use blood from HHC patients.
To learn more about blood safety, transfusion and blood donation visit:
American Association of Blood Banks
Web site: www.aabb.org
Americas Blood Centers
Web site: www.americasblood.org
The National Library of Medicine
Web site: www.nlm.nih.gov/medlineplus/bloodtransfusionanddonation.html
The US Centers for Disease Control and Prevention
Web site: www.cdc.gov/ncbddd/hbd/blood_safety_facts.htm
To find a blood center with FDA variance that offers a hemochromatosis donor program, visit: (link to our registry)