Blood Transfusion, Pregnancy, and Childbirth

What is a Blood Transfusion?

A blood transfusion involves giving blood or blood components from one person (the donor) to another person. It is usually done to replace blood that has been lost because of severe bleeding, but it is also used for the treatment of severe anaemia (low hemoglobin).

Why is Blood Important?

Blood is important because it supplies your body with the oxygen and nutrients it needs. Blood also carries away waste products. Blood is made up of red blood cells, platelets, and white blood cells in a fluid called plasma. These components each have different jobs to do:

• Red blood cells contain an iron-rich pigment called hemoglobin that carries oxygen around the body.
• Platelets control bleeding by helping the blood to clot.
• White blood cells fight infection and form part of the body's defense system (immune system).

What is Anaemia?

Anaemia is when the level of hemoglobin in your blood is lower than normal. It can cause tiredness, breathlessness, fainting, headaches, and a faster heartbeat. Your hemoglobin level will be routinely checked at your first pregnancy appointment and at around 28 weeks. Severe anaemia is when the level of hemoglobin is very much lower than normal. It can make you feel very unwell, with symptoms like dizziness, breathlessness, and chest pain.

Why Might I Need a Blood Transfusion?

In a Non-Emergency Situation: You may be offered a blood transfusion in a non-emergency situation if:

• You are very anaemic just before your baby is due. In this case, there is a risk that, if you bleed even a small amount during birth, you may become severely anaemic.
• You bleed heavily during birth, but the bleeding has stopped. If you are very anaemic and/or unwell, making it difficult for you to care for your baby, you may be offered a blood transfusion to restore your hemoglobin level. This may be soon after birth or on the postnatal ward if you are dizzy or short of breath when you are up and about. You are unlikely to be offered a transfusion unless you have symptoms and feel unwell.
• You have sickle cell disease or thalassemia. These conditions affect your body's ability to produce healthy hemoglobin.

In an Emergency Situation: If you haemorrhage (bleed very heavily), this is an emergency situation. As a result of heavy bleeding, you can become severely anaemic. Without a transfusion to replace the blood you have lost, you could become seriously ill. A haemorrhage can happen:

• Early in pregnancy if you have a miscarriage or an ectopic pregnancy (when the pregnancy grows outside the womb).
• After 24 weeks of pregnancy, when it is called an antepartum haemorrhage.
• During birth, or immediately after birth (known as a postpartum haemorrhage).

How Safe is the Blood I Get?

All blood donations are tested for viruses such as hepatitis and HIV. Only blood that is free from these infections is used in a blood transfusion. The risk of getting an infection from a blood transfusion is very, very low.

How is the Blood Matched?

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

Is a Blood Transfusion Always My Only Option?

• Iron Tablets/Syrup: If you have anaemia because of blood loss or lack of iron, you may be offered iron tablets or syrup to restore your hemoglobin level instead of a blood transfusion. It will take longer for you to feel completely well, but you avoid the minimal risks associated with a blood transfusion. After you have had your baby, if your symptoms are mild and you have support at home, you may decide to take iron tablets or syrup rather than having a blood transfusion.
• Iron Infusion: If you are unable to take iron tablets or your anaemia doesn't respond to iron tablets or syrup, you may be offered an iron infusion. The iron is given through a drip in your arm. It is safe for you and your baby, and side effects are rare. An iron infusion works more quickly than iron tablets or syrup.

What Can I Do to Prevent Anaemia?

To produce hemoglobin, the body needs iron, vitamin B12, and folic acid. If there is a lack of one or more of these, you become anaemic. The additional demands that pregnancy makes on your body increase the risk of anaemia. You can reduce the chance of becoming anaemic by having a varied diet and enough iron in your diet (iron-containing foods include meat, poultry, eggs, vegetables, and cereals). Ensuring that every pregnant woman’s haemoglobin is normal as its connected to normal level during pregnancy and childbirth is important to reduce blood transfusion.

Remember, blood transfusions are a valuable tool in ensuring a safe pregnancy journey. Knowing when they might be necessary and the factors involved can empower you and your family to navigate unexpected situations with confidence.

Dr. Bhargavi Reddy K, Consultant - Obstetrics and Gynecology, BirthRight by Rainbow Hospitals, Banjara Hills, Hyderabad