Questioning the need for blood transfusion

Have Jehovah’s witnesses been right all along? About blood transfusion, that is.

There is increasing evidence that a “liberal” approach to the transfusion of blood is the wrong approach. For instance, transfusion seems to increase the risk of infection. But it’s not the kind of infection that most people worry about, dread viruses like hepatitis or HIV. Rather, transfusion inhibits the immune system and leads to higher rates of so-called nosocomial, or hospital-acquired, bacterial infection (bloodstream infections, pneumonia, urinary infection).

There’s even a seldom appreciated increased risk of acquiring cancer over subsequent years.

A new retrospective study has shown that banked blood stored for more than 4 weeks is associated with more infection in the patients who receive it. Blood is scarce and expensive, and most blood banks store it for up to 42 days before administration.

What’s the right perspective? Except for certain religious groups blood transfusion isn’t evil and, as always, an appreciation of risks and benefits is necessary. Blood can be life-saving. And patients with severe heart or lung disease, for example, do poorly without transfusion in circumstances that healthier people easily tolerate.

What you can do

  1. If you are in a position to do so – e.g. before elective joint surgery – it’s wise to ask a few questions of your doctor about blood transfusion. The right questions, plus a lot useful information, is contained in a nice booklet (PDF) put out by the Society for Advancement of Blood Management.
  2. If you are about to undergo surgery in which significant blood loss is expected, your hemoglobin level should be checked ahead of time. A low level (anemia) detected only in hospital could lead to an unnecessary blood transfusion, avoidable through the administration of iron, by mouth, or an injection of erythropoietin, a drug that stimulates the body to produce red blood cells.
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