Blood transfusion is often a life-saving procedure, necessary not only for accident victims, but also for those suffering from a number of serious diseases. When is a blood or blood transfusion necessary? When is a doctor not allowed to perform a blood transfusion, even to save a life? Do parents have the right to refuse consent to a child's blood transfusion?
Blood transfusionis the transfusion of a certain amount of blood or blood products in order to replenish its deficiency, after obtaining the patient's consent for the treatment. According to the data of the website kulniacy.pl, in Poland, up to 2 million blood transfusions or blood products are performed each year.
Transfusion of blood or blood products: when is it necessary?
The human body is able to cope with the loss of a small amount of blood - then within a few weeks it produces new red blood cells. However, if moreblood has been lost, ablood transfusion is the only way to quickly replenish the blood deficiency and thus save a life. Therefore, the decision to transfuse blood is made in cases where the patient cannot be treated in any other way, and the benefits of the procedure outweigh the risks associated with possible complications.
Whole blood transfusionis a procedure that is performed very rarely due to the risk of reactions related to the administration of unnecessary elements. Therefore, whole blood transfusions are only performed in a few cases:
- massive hemorrhage, i.e. when there is a sudden and significant blood loss (30-60%)
- surgical procedures
- in dialysis and extracorporeal circulation
- with swap transfers
Usually only those blood components that are found to be deficient are transfused.
1. Red blood cell transfusion (RBC)
Red blood cell transfusionis used to treat anemia (deficiency of red blood cells). An anemic organism does not produce enough red blood cells to carry oxygen, which is essential for the proper functioning of the body.
This typeblood transfusionmay also be needed in a patient who is undergoingchemotherapy. Synthetic chemicals used to fight cancer (including blood cancer) can reduce the body's ability to produce new red blood cells during treatment.
In addition, blood transfusion may be necessary in the case of bleeding ulcers, gastrointestinal tumors.
2. White blood cell transfusion
White blood cells are administered in the case of a life-threatening deficiency of granulocytes (white blood cells - leukocytes - containing granules) or the leukopenic-infective syndrome.
3. Platelet cell concentrate (KKP) transfusion
In the case of thrombocytopenia, i.e. when platelets are deficient or if the platelets are not functioning properly, a platelet concentrate transfusion is required.
4. Plasma preparations are used in the case of
- bleeding in patients with hemorrhagic diathesis, also inborn (e.g. in the treatment of hemophilia, von Willebrand's disease) - thenclotting factor concentrates
- immunological diseases, in the prevention of a serological conflict between the mother and the fetus, in order to prevent certain infectious diseases and in antibody deficiency syndromes - this is an indication for transfusionimmunoglobulins
- hypoproteinemia (deficiency in blood), i.e. states of protein deficiency in tissues and organs, and hypoalbuminemia, i.e. when plasma albumin is reduced. Then it is necessary to transfusealbumin
If your doctor is going to perform a blood transfusion on a patient, he or she should explain why it is necessary. He should also present possible alternatives and state that he has the possibility to refuse. The patient should consent to the transfusion in writing.
If a given patient had to have a blood transfusion, e.g. as a result of an accident, without the possibility of asking him for opinion, after the procedure the doctor should explain the reasons for the transfusion and provide this information in the form of medical documentation.
Blood autotransfusion - when might it be needed?
Autotransfusion, i.e. transfusion of the patient's own, previously collected blood, may be necessary during planned vascular, urological, cardiosurgical, orthopedic, gynecological and other procedures.
Religious reasons for giving up blood transfusions
There are cases when, despite the need to perform a blood transfusion, the patient does not agree to the procedure. This applies primarily to Jehovah's Witnesses who do not agree to transfusion of whole blood and its parts, even in a life-threatening situation.It is worth knowing that a doctor who transfuses blood to a sick Jehovah's Witness without informing him about it may be prosecuted even if the procedure was necessary to save his life, e.g. in the event of a haemorrhage during an operation.
The doctor should not transfuse the patient's blood when the patient:
- is of legal age and aware of his obligation to be responsible for his life and he alth
- has been informed by the doctor about all the consequences of resigning from the transfusion
- made the decision freely, trusting that in this way he fulfills the moral imperative of his religion
Lack of consent requires a written statement from the patient.
ImportantNo parental consent for child's blood transfusion
According to international law - the provisions of the Universal Declaration of Human Rights and the European Convention on Human Rights - a doctor may take action to save a child's life, even against the will of the parents, motivated by religious reasons. What's more, the doctor may protect the child's right to he alth against the will of the parents, even if there was no immediate threat to his life.
Bibliography:
Szczepaniak L.,Ethical aspects of resignation from blood transfusion for religious reasons , "Medycyna Praktyczna" 2010, nr 2
Medicine and rights human , trans. Kaczyńska I., Sejm Publishing House, Warsaw 1996