Blood is transfused only by hospital staff, usually registered nurses, trained to administer blood and recognize complications arising from transfusion. Of utmost importance is the proper identification of the intended recipient; erroneous administration of ABO-mismatched blood -- which is rare -- is virtually always due to patient misidentification at some point in the process.
The most frequent complications, fortunately, are mild and readily treatable. These include low-grade fever (usually due to contaminating white blood cells in the donor product), simple allergic reactions (hives), and mild fluid overload. Hospital blood banks, however, must perform tests to exclude reactions resulting from more serious causes such as recipient antibodies reacting against and destroying donor red blood cells (i.e., a hemolytic reaction). Rarely, bacteria are found to contaminate donor components, usually platelets since they are stored at room temperature.
There are a multitude of questions that remain unanswered at this time. Which patients are most apt to benefit from blood transfusion, and what are the best indicators for the need for transfusion (i.e., transfusion triggers)? How can the risk of transmissible diseases such as HIV and viral hepatitis be further reduced (considering that the risk is already miniscule)? What is the risk of prion-disease (CJD) transmission by transfusion of blood? What role will artificial blood (blood substitutes) play once they become licensed for use? What are the long-term effects of blood transfusion (including the effects of white blood cell contaminants)? Perhaps most significant at this time is the question, How we can motivate the population to voluntarily donate blood on a regular basis? It will only be through the dedication of healthy, volunteer blood donors that will enable us to maintain an adequate and safest-possible supply.
Dr. Neville Colman
Chairman of Pathology
Continuum Health Partners
Dr. Mark Friedman
Associate Director of the Blood Bank
St. Luke's/Roosevelt Hospital Center