What You Need to Know About Blood Transfusions and IBD

There may be times when people with inflammatory bowel disease (IBD) would need to receive blood from a donor, such as during a surgical procedure or if too much blood is lost through bleeding in the gastrointestinal tract. There are risks involved with receiving a blood transfusion, but in general, it is a procedure that is well-tolerated and, as we all know, it can save lives.

Blood Donation

Typically, blood is donated by volunteers who are screened and “accepted” to give blood. The screening process includes questions about overall health and about any risk factors for disease. Blood is only taken from donors who are designated as healthy enough to do so. The donated blood is tested to determine the type (A, B, AB, or O). It is also screened for the presence of:

• Hepatitis B
• Hepatitis C
• HIV
• HTLV (human T-lymphotropic viruses)
• West Nile virus
• Treponema pallidum (syphilis)
• Zika virus
• Trypanosoma cruzi (Chagas disease)

In some circumstances, blood may also be screened for other infectious diseases.

Blood can also be taken and stored for one’s own future use, or be donated by a relative. Most often, a person’s own blood is drawn and stored in advance of a surgery where a transfusion may be needed. This, of course, can only be done in cases where the need is anticipated. Relatives may also donate blood for direct use by a patient, although this is not typically considered any safer than blood from a volunteer.

Procedure

When a patient needs blood, a suitable match is found among donor blood. Cross-matching is done to ensure that the immune system of the person receiving the blood will not reject it. Blood from the donor is matched to the type and Rh factor of the recipient. The cross-matching is verified several times, including at the bedside of the patient, to ensure that the correct blood type is given.

A blood transfusion is done intravenously, typically over a few hours.

Possible Adverse Events

Febrile nonhemolytic transfusion reaction: The most common adverse event in blood transfusions is a febrile nonhemolytic transfusion reaction. This reaction may cause symptoms of fever, chills, and shortness of breath, but these are self-limiting and do not lead to a more serious complication. This event occurs in approximately 1 per every 900 units of blood transfused.

Acute hemolytic transfusion reaction: In an acute hemolytic reaction, antibodies from the immune system of the patient receiving the blood attack the donor blood cells and destroy them. Hemoglobin from the donor blood is released during cell destruction, which may lead to kidney failure. The risk of this event is estimated at 1 per every 100,000 to 200,000 units of blood transfused.

Anaphylactic reaction: This is a rare but severe allergic reaction that may be caused by the recipient reacting to the donor’s plasma. This is potentially life-threatening and can occur during the transfusion procedure or several hours afterward. The risk of an anaphylactic reaction is approximately 1 per 30,000 units of blood transfused.

Transfusion-associated graft-vs-host disease (GVHD): This very rare complication primarily occurs in severely immunosuppressed recipients. Incompatible white blood cells from the donor blood attack the recipient’s lymphoid tissue. GVHD is almost always fatal, but this complication may be prevented with the use of irradiated blood. Blood may be irradiated if it is going to be given to a recipient who is at risk for GVHD.

Viral infection: While the risk of infection is decreased due to the screening process that donors and donated blood undergo, there is still a risk of these infections. Data from testing of samples from almost 15 million blood donations in the United States found viruses at rates of:

• Hepatitis B: 8 in 100,000
• Hepatitis C: 2 in 10,000
• HIV: 3 in 100,000
• HTLV: 3 in 100,000

Bacterial infection: A bacterial infection can be transmitted if there are bacteria in the donated blood. Blood can become contaminated with bacteria during or after collection, or during storage. The risk of a severe infection is approximately 1 in 100,000 transfusions, and the risk of a fatal infection is approximately 1 in 500,000 transfusions.

Other diseases: Other viruses (cytomegalovirus, herpesviruses, Epstein-Barr virus), diseases (Lyme disease, Creutzfeldt-Jakob disease, brucellosis, leishmaniasis), and parasites (such as those which cause malaria and toxoplasmosis) can potentially be transmitted through a blood transfusion, but these are rare.