Consultation with the Specialist: Red Blood Cell Transfusions

Abstract

1. Moshe D. Bell, MD* 1. *The Valerie Fund Children's Center for Cancer and Blood Disorders, Children's Hospital of New Jersey, at Newark Beth Israel Medical Center, Newark, NJ After completing this article, readers should be able to: 1. Discuss the complications of a red blood cell transfusion for a child who has autoimmune hemolytic anemia. 2. Delineate the risk of transmitting infectious diseases during blood transfusions. 3. Describe the hemolytic, febrile, and urticarial reactions that may be associated with red blood cell transfusions. 4. Explain the role of red blood cell transfusions in the management of anemia. Red blood cells (RBCs) carry hemoglobin-bound oxygen from the lungs to capillaries, where they release some of their oxygen for diffusion into surrounding tissues that have lower oxygen tension. The ability to increase cardiac output and to shift the oxygen dissociation curve of hemoglobin allows the body, in most instances, to compensate for loss of oxygen-carrying capacity, increased tissue need, or hypoxia. In some circumstances, however, the compensatory mechanisms are insufficient, and RBC transfusion may be beneficial. The first reported blood transfusion took place between two dogs in 1666 at Oxford University in an experiment by Richard Lower. By the following year, French physician Jean Denys was transfusing blood from lambs and calves into patients afflicted with mental illness, hoping to balance their “humors” with those of the docile, domesticated animals. Many transfusion recipients had acute hemolytic reactions, and some died (Denys was tried for murder in one instance), essentially putting a halt to the use of blood transfusions for more than a century. In 1818, British obstetrician James Blundell performed the first known human-to-human transfusions, reporting success in some women who had severe postpartum hemorrhage. By mid-century, the first transfusions in the United States were performed, but they remained rare until the 20th century. The early 1900s brought major advances in transfusion medicine, starting with Karl Landesteiner's discovery and description of the ABO blood grouping system (he called it ABC) and, subsequently, the Rh …