Blood Transfusions During Pregnancy

Woman getting a blood transfusion during her pregnancy

A blood transfusion is a frequently performed procedure where you receive blood through an intravenous (IV) line into one of your blood vessels.  Receiving a blood transfusion while pregnant is not something most women want to think about. However, there are two conditions that may warrant a blood transfusion during pregnancy.

What are the Reasons to Have a Blood Transfusion During Pregnancy?

There are two primary reasons you may need a blood transfusion while pregnant. These include the development of severe anemia close to your due date or hemorrhaging at some point during your pregnancy.

You can find more information on both below:

Iron-Deficient Anemia

Once a hemoglobin estimate has been performed, a medical professional can diagnose the extent of your anemia. For patients diagnosed with severe anemia, it is important to determine the causes and best course of treatment. While it may be difficult to pinpoint exact causes of anemia, particularly if a combination of factors has resulted in anemia, sometimes the frequency of anemia in a given region may give a clue as to its cause. For instance, in areas where malaria is common, the course of treatment will be tailored to take into account the possibility of malaria. Your doctor will prescribe antimalarials possibly in combination with another treatment.

If you have a hemoglobin count lower than 7 g/dl and are 34 weeks along in your pregnancy or more, the possibility of transfusion will be discussed. A hemoglobin measure lower than 5 g/dl greatly increases your risk of mortality. It is crucial that you receive a transfusion before very severe anemia develops. In addition, it is imperative that severe anemia is effectively treated before labor. Often, relatives who are willing to donate blood are asked to provide the transfusion.

Hemorrhage

Hemorrhaging is bleeding excessively in an urgent situation. This bleeding can lead to severe anemia. A transfusion is often required in order to counteract excessive blood loss. Hemorrhaging can occur at any time during pregnancy. If you experience a miscarriage or ectopic pregnancy, it can lead to hemorrhaging early in your pregnancy. It is also possible to experience hemorrhaging after your 24th week of pregnancy. You are probably more familiar with the possibility of hemorrhaging during delivery and immediately following delivery, known as intrapartum hemorrhaging and postpartum hemorrhaging respectively. While doctors will try to prevent the need for a blood transfusion, under some conditions it is absolutely necessary to save you and your baby’s life.

Having a Blood Transfusion During Pregnancy

Most often, the transfusion required for pregnant and recently pregnant women only involves red blood cells.  It is less likely platelets and plasma will be needed. In order to receive the transfusion, a small tube will be inserted into a vein in your hand or arm. The transfusing blood will move through a drip into your body. Each bag contains approximately 1/3 of a liter of blood and takes an estimated 3 hours to fully transfuse. In some cases, this rate of transfusion can be expedited.

What are the Side Effects of a Blood Transfusion While Pregnant

You will be closely monitored during any blood transfusion while pregnant by a health care professional. Minor side effects include:

These side effects can be alleviated by medication and typically get better in one day.

More serious complications include the following:

  • Difficulty breathing
  • Severe headache
  • Abrupt drop in blood pressure that may be characterized as life-threatening

Once you experience side effects, the transfusion will be halted, and your current situation will be assessed before proceeding. Under conditions of massive transfusion or multiple transfusions, more severe complications may arise.

These complications include:

  • Hypothermia
  • Hyperkalemia – electrolyte imbalance involving low potassium levels
  • Hypocalcemia – low calcium levels
  • Coagulopathy – clotting factors are diluted leading to weakened or impaired coagulation
  • 2, 3-DPG depletion – depletion of a blood component that regulates how easily oxygen is moved from hemoglobin into tissue
  • Jaundice
  • Infection
  • Alloimmunization
  • Transfusion Reactions

When these severe side effects are experienced, a medical team will intervene.

Blood Transfusions During Pregnancy: Final Notes

If you’re asked to undergo a blood transfusion, make sure to get a full understanding of all of the options available to you. If it is an emergency situation, a doctor will likely make an educated decision for you. You can decline a blood transfusion or change your mind about receiving one at any time, but be aware that under some circumstances a blood transfusion may be the only way to keep you alive. If you have any questions about your options or concerns about the safety of blood transfusions, you can ask your doctor or midwife.

Compiled from the Following References:

Cohen, Wayne R.  (2000).  Postpartum Hemorrhage and Hemorrhagic Shock in Cohen, Wayne R. (Ed.), Complications of Pregnancy, 5th edition (812-3).  Philadelphia, PA: Lippincott Williams & Wilkins.

MacDonald, R.  (1977).  Red cell 2,3-diphosphoglycerate and oxygen affinity.  Anaesthesia, 32(6).  Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/327846

Royal College of Obstetricians and Gynaecologists.  (2009, Feb. 20).  Blood transfusion, pregnancy and birth – information for you.  Retrieved from: http://www.rcog.org.uk/blood-transfusion-pregnancy-and-birth

Royal College of Obstetricians and Gynaecologists.  (2009, Feb.).  Blood transfusion, pregnancy and birth – information for you. Pamphlet.  Retrieved form: http://www.rcog.org.uk/files/rcog-corp/Blood%20Transfusion,%20Pregnancy%20and%20Birth.pdf

Walraven G. Treatments for iron-deficiency anaemia in pregnancy: RHL practical aspects (last revised: 20 June 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.  Retrieved from: http://apps.who.int/rhl/pregnancy_childbirth/medical/anaemia/gwguide/en/