Blood transfusion in pregnancy

A blood transfusion involves the transfer of blood or blood components from one person (the donor) to another person (the recipient). A blood transfusion can be a life-saving process. It is often done to replace blood that has been lost due to severe bleeding or in some cases for the treatment of severe anaemia.

Blood is important because it supplies your body with the oxygen and nutrients it needs to function. Blood also carries away waste products such as carbon dioxide.

Why is a blood transfusion needed?Show [+]Hide [-]

In an emergency situation if you haemorrhage (bleed very heavily) you can become severely anaemic. Without a transfusion to replace the blood you have lost, you could be very ill or even die.

A haemorrhage can happen:

  • early in pregnancy if you have an ectopic pregnancy (when the pregnancy is growing outside the uterus) or a miscarriage
  • after 24 weeks of pregnancy (antepartum haemorrhage)
  • during birth (intrapartum haemorrhage)
  • immediately after birth (postpartum haemorrhage).

Even with excellent care in pregnancy and monitoring during labour, it is not possible to predict or detect every complication in time to prevent a lifethreatening bleed. Surgical techniques and medication will be used to try to limit the need for a blood transfusion but a blood transfusion might be needed to save your life or to prevent serious harm to your health and your baby’s health.

You may be offered a blood transfusion in a non-emergency situation if:

  • If you have anaemia just before you are expecting your baby, there is a risk that if you bleed even a small amount during birth, you may become severely anaemic.
  • If you have anaemia immediately after birth, you may be offered a blood transfusion, depending on your symptoms.
  • If you have a blood condition, such as sickle cell disease or thalassaemia, it affects your body’s ability to produce healthy haemoglobin.
  • If you bleed heavily during or after birth.
  •  If you bled heavily during birth your haemoglobin level will be monitored.
  • If you are very anaemic and unwell, making it difficult for you to care for your baby, you may be offered a blood transfusion to restore your haemoglobin level.

Your doctor may discuss alternative options to avoid transfusion and restore the haemoglobin to normal.

How safe is the blood I get?Show [+]Hide [-]

All blood donations in the UK are tested for viruses such as hepatitis and HIV. Only blood that is free from these infections is used in a blood transfusion. The chance of getting an infection from a blood transfusion is very, very rare. You can get further information from:

How is the blood matched?

There are four main blood groups: A, B, AB and O. Blood is also rhesus (RhD) positive or negative. In the laboratory your blood is tested and compared with the donor blood to make sure that it matches.

During a transfusionShow [+]Hide [-]

Most transfusions during pregnancy and after birth are given as red blood cells only. Very occasionally, platelets and plasma may be required as well.

A cannula (small tube) is placed into a vein in your hand or arm. The tube is attached to a drip and donor blood flows through the drip. Blood for transfusion is stored in small plastic bags containing a unit of blood which is about a third of a litre. Each unit of blood takes about 3 hours to transfuse. In an emergency, blood may be transfused more quickly. You are carefully monitored before and during the transfusion. Your midwife will take your blood pressure, temperature and heart rate during the transfusion.

Some people get mild side effects, such as headaches, chills and fever, a rash and itchiness. These symptoms are relieved by drugs, such as paracetamol, and will improve within a day or so.

Very rarely, there may be more severe side effects, including difficulty in breathing, severe headaches and a sudden fall in blood pressure which can be life- threatening.If you get side effects, the transfusion will be stopped immediately and the situation reviewed.

After a transfusionShow [+]Hide [-]

Once all the blood has been transfused, the drip is taken down. Your haemoglobin level will be rechecked to make sure that you have received enough blood. Most women do not need another transfusion.

Making the decision to have a blood transfusion If you are offered a blood transfusion, make sure you have all the information you need to make an informed decision. Ask for information about all your options. If you have any concerns about having a blood transfusion, speak with your obstetrician or midwife.

What happens in an emergency?Show [+]Hide [-]

In an emergency your doctors need to act immediately. Your obstetrician, anaesthetist and haematologist (a doctor who specialises in the treatment of diseases of the blood) will make an informed decision on your behalf for you to have a blood transfusion.

What if I want to refuse a blood transfusion?Show [+]Hide [-]

You may decide you do not want to have a blood transfusion. This may be because of personal reasons or because of religious beliefs. You can change your mind at any point about the use of blood. You should not feel as though you have to stick rigidly to your original decision. Unforeseen circumstances sometimes influence events, resulting in previous decisions needing to be changed.

If you would not accept the use of blood products in your pregnancy or after you have given birth, we would like to make an appointment for you to see one of our doctors in the Obstetric Haematology Clinic at the RVI.

In this clinic we will:

  • Check your blood count so that if you do become anaemic a treatment can be offered to you that is acceptable.
  • Offer you low dose iron therapy (usually ferrous sulphate tablets) to use in pregnancy. This will help prevent you from becoming anaemic.
  • Document clearly in your hospital notes where the placenta is situated in the womb and make a detailed plan of care for you if it is low-lying (placenta praevia). 
  • Confirm exactly which medications and fluids are acceptable, and not acceptable to you, if you experience problems with bleeding in the pregnancy or after you have given birth.
  • Make sure that you are well informed about any new advances like the use of cell salvage and artificial blood clotting agents, so  that you can decide whether their use would be acceptable to you or not.
  • Write your preferences clearly into your hand-held notes and your hospital notes.
  • File a copy of your Advanced Directive into your hospital notes (please bring a copy with you when you come for your ante-natal appointment).

Your views will be treat with the utmost respect at all times and there will be no attempt made to persuade you to accept anything that clashes with your preferences or beliefs.

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