Blood Transfusion

June 12, 2024 

This page was reviewed under our medical and editorial policy by Leslie Popplewell, M.D., hematologist and medical director of Hematology and Blood and Bone Marrow Transplant, City of Hope^® Cancer Center Atlanta

The American Red Cross estimates that one-quarter of the blood supply in the United States is used to provide lifesaving treatments for people diagnosed with cancer. Those with blood cancers such as leukemia are especially likely to require blood transfusions since these types of cancers affect blood cell production.

A doctor may recommend a blood transfusion for cancer due to side effects from treatments such as surgery or because the disease may trigger internal bleeding or a reduction in the number of healthy cells and clotting agents.

What Is a Blood Transfusion?

Blood transfusions are whole blood or blood components given by a donor and inserted into a patient’s blood vessels using an intravenous (IV) line.

In addition to whole blood transfusions, donated blood products include red blood cells, granulocytes (white blood cells), blood platelets and plasma and its components.

Types of Blood Transfusion

Multiple types of blood transfusions are used to help meet the needs of cancer patients. Some may be referred to as blood infusions. A blood infusion is simply an IV medication administered directly into a vein using a pump (or sometimes gravity) to manage the rate of delivery. The type of blood transfusion that a patient receives will depend on their specific diagnosis and symptoms. These include those listed below.

Red blood cell (RBC) transfusions: RBCs contain a protein called hemoglobin that transports oxygen throughout the body. Some tumors, blood cancers and cancer treatments such as radiation therapy and chemotherapy damage or destroy RBCs, making transfusions necessary. Since hemoglobin also stores iron, patients who are on a regular schedule for these transfusions may receive a drug called iron chelator to help prevent iron overload.

Platelet transfusions: Certain cancers such as leukemia and lymphoma affect the bone marrow’s ability to produce platelets. Since platelets help the blood clot, low levels may lead to issues such as nosebleeds, excessive bleeding from cuts and scrapes, skin bruising and even internal bleeding. Platelet transfusions may help reduce bleeding before it becomes serious.

Granulocyte (white blood cell) transfusions: Granulocytes are cells that are key to helping the body fight infection. Low granulocyte levels may lead to antibiotic-resistant infections. To help maximize the granulocytes in transfusions, some donors take a drug that triggers their production before the donation.

Albumin transfusions: Albumin is an important protein that helps keep the blood from leaking, transports medicines and aids in tissue healing and growth. Patients who have serious issues with proper liver functioning may need an albumin transfusion, although the procedure is rare.

Plasma transfusions: Blood plasma contains clotting factors to help the blood coagulate (thicken). Certain cancers trigger disseminated intravascular coagulation (DIC), which depletes these clotting factors. Plasma transfusions enable the body to get the clotting factors it needs to counter this condition.

Cryoprecipitate transfusion: A cryoprecipitate transfusion is a type of plasma transfusion that contains a higher concentration of key clotting factors.

IV gamma globulin: Gamma globulins are proteins in plasma that help the immune system fight infections. Patients with chronic lymphocytic leukemia may need IV gamma globulin because they tend to have low levels of these proteins, increasing their risk for bacterial infections. IV gamma globulin is sometimes called intravenous immunoglobulin (IVIG) infusion.

Why Do Cancer Patients Need Blood Transfusions?

People with cancer may require a blood transfusion for a variety of reasons, including those listed below.

Anemia: This condition is characterized by low levels of red blood cells. One reason it develops is because blood cancer cells from diseases such as leukemia or lymphoma push out healthy RBCs. Multiple myeloma, cancers that spread to the bone, chemotherapy and other cancer treatments may also damage the bone marrow where RBCs are produced, triggering anemia.

Thrombocytopenia: This is the medical term for low blood platelet counts, which may be due to cancer in the spleen, cancer that spreads to the bones, leukemia, lymphoma, multiple myeloma, chemotherapy medications or other types of cancer and cancer treatments.

Low white blood cell (WBC) levels: Similar to RBCs and platelets, white blood cell levels may be reduced due to bone marrow damage from treatments such as chemotherapy and radiation therapy, or they may be pushed out by cancer cells.

Vomiting or poor appetite: Cancer symptoms or side effects of cancer treatment may include nausea, vomiting and loss of appetite, leading to a loss of nutrients like iron, folic acid and vitamin B12. This nutritional deficit may reduce the body’s ability to make RBCs.

Disseminated intravascular coagulation (DIC): This is a condition that initially causes the blood to coagulate (thicken) too much, leading to blood clots. As platelets and blood plasma proteins known as clotting factors are used up, DIC enters its second stage, in which patients may experience bleeding below the skin, internally, and from the nose and mouth. Several types of cancer may trigger DIC, including ovarian, leukemia, melanoma, stomach, kidney and gallbladder cancer.

Internal bleeding: As cancer tumors grow and spread, they may injure the blood vessels in tissues and organs, causing bleeding inside the body.

Cancer that either spreads to the liver or starts there: The liver makes a lot of the clotting factor that helps stop excessive bleeding, and liver damage from cancer may disrupt its ability to produce this clotting factor.

Certain cancer treatments: Patients undergoing chemotherapy, radiation therapy and bone marrow transplant may need a blood transfusion, as these treatments may damage the marrow where blood platelets, RBCs and WBCs are made. Certain other cancer treatments may also interrupt vital blood system processes, such as angiogenesis inhibitor drugs that curb new blood vessel growth.

Loss of blood from surgery: Patients undergoing cancer surgeries to remove tumors and surrounding lymph nodes may bleed during the operation. A blood transfusion may be required to increase blood volume.

How Many Blood Transfusions Can a Cancer Patient Have?

There is no standard limit on the quantity of blood transfusions that people may receive, including cancer patients. The patient’s care team determines the type and frequency of transfusions that each patient may need. Factors such as the type of cancer, its impacts on the body, the patient’s age and health status, the types of cancer treatments a patient receives and how they respond to them are all taken into consideration.

For example, a blood transfusion for leukemia patients may be more common than for patients with other types of cancer because the condition impacts the blood and bone marrow in ways that reduce healthy blood cell and platelet levels.

While blood transfusions are fairly common with leukemia, patients with other types of cancer, such as lymphoma and myeloma, may also require blood transfusions to give their bodies the healthy cells they need. Patients who develop anemia may be given transfusions before more serious symptoms appear, especially if they are older, have cardiovascular system conditions or both.

Blood Transfusion Procedure

Blood transfusion procedures take place at hospitals, outpatient clinics or during at-home nursing visits. The length of time for the procedure varies, depending on such factors as the type of transfusion and the health conditions a person may be experiencing.

• Plasma and platelet transfusions typically take less than a half-hour.
• RBC and whole blood transfusions may take two to four hours.
• Health conditions such as heart failure may slow transfusion times.

Here is what patients may expect before, during and after a blood transfusion procedure:

• The patient reads and signs an informed consent form, outlining the risks, benefits and alternatives to a blood transfusion. (Life-threatening cases may be exempt from this.)
• Lab tests are conducted to check blood type and other information about a patient’s blood.
• A blood bank locates blood that matches the patient’s blood type.
• Just prior to the procedure, a health care professional records the patient’s temperature, heart rate and blood pressure and monitors these throughout the procedure.
• If an IV or central line isn’t already in place, the nurse places an IV into a vein in the patient’s arm.
• Safety checks are performed by the nurse or other medical professional overseeing the procedure, and information about the procedure is reviewed with the patient.
• The blood is transfused at a slow rate for about 15 minutes to check for a reaction, and the transfusion speed is then increased if no reaction occurs.

After the procedure, the patient’s arm may be slightly sore, but they may resume normal activities as long as no side effects are present.

Risks of Blood Transfusion

While most people do not encounter complications from blood transfusions, some side effects and symptoms may occur either during or shortly after the procedure, including:

• A fever that comes on within 24 hours of the transfusion (most common reaction)
• Rash or hives
• Itching
• Dark-colored urine
• Back pain
• Chest pain
• Dizziness
• Nausea
• Headaches
• Chills
• Swelling of the lips, mouth or tongue
• Problems breathing
• Coughing that started after the procedure

Although it is rarely the case, these reactions may be a sign of a hemolytic transfusion reaction, which occurs when the donor’s blood does not match the patient’s. This is why a patient needs to let the nurse or doctor know right away if he or she is having these reactions.

Some other (delayed) complications that may arise from blood transfusions include those listed below.

Graft-versus-host disease, a very rare condition in which the patient’s immune system is attacked by donor white blood cells, which may be prevented by treating the donor blood with radiation prior to transfusion. This is typically only an issue with severely immunosuppressed patients, which is why transfused units of blood are irradiated before being administered to patients with allogeneic transplants.

Viral infection transmission, including transmission of a common virus called cytomegalovirus, which has become less common over the last 20 years due to more sensitive testing procedures. Cancer centers have extremely stringent screening processes for potential donors, as well as strict testing on collected units of blood and blood components to greatly reduce the risk of infection.

Bacterial infection transmission, which is more common in platelet transfusions and rare in RBC transfusions

Alloimmunization, a condition in which the patient’s immune system produces antibodies that attack some of the antigens from the donor blood

The knowledgeable oncologists at City of Hope^® have expertise in a diverse range of cancer treatments and provide expert guidance on blood transfusion risks, benefits and treatment plans that properly address the cancer impacts each patient is experiencing.