Essay on Blood Transfusion

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Should a parent have the right to refuse a blood transfusion?

Introduction

Blood transfusion is an important process that involves saving lives. Life threatening situations arise every day as a result of accidents, surgeries and diseases like severe anemia, hemophilia, sickle cell disease and massive trauma among others. These situations can lead to death, especially in serious cases, when the patient fails to receive immediate blood transfusion to replace the lost blood. Many people fail to understand how important blood transfusion is; hence their failure to donate blood. In this essay, I hope to do a research on the views of other people concerning blood transfusion to be able to understand their views and opinions. (Edelson M. F, 2006)

Controversies on blood transfusion

There have been controversies concerning blood transfusion, one of the major concerns being the transmission of diseases from the donors to the recipients. Debates have arisen based on whether blood transfusion is worth the risk due to spread of the diseases. Blood transfusion increases the risk of the patient being infected with dangerous diseases like HIV among many others. An example of such a case was reported at the Minnesota department of health, where a patient who had undergone multiple blood transfusions was reported to have contacted the Anaplasma phagocytophilum, a bacterium of neutrophils which causes human anaplasmosis. Following an investigation, it was reported that the transmission was acquired through a transfusion of red blood cells. (JAMA, 2007, vol 300, issue 23) In this case, the controversy is arisen in that the doctors failed examine the blood donors carefully before the donation.

A case is reported whereby a child was involved in a road accident and sustained severe injuries and lost blood. The parents refused to accept blood transfusion as away of treating the child because they were Jehovah’s Witnesses. However, the doctors realized that the only way to save that child was through a blood transfusion which they went ahead and did without the parents’ consent and saved that child’s life. (Boyd.p.152).This is an issue whereby parents’ rights collide with the child’s right to life. In such a case, the parents’ rights can be overruled in order to protect the child’s right to life. The child is entitled to his rights as much as adults are entitled to theirs.

Other controversies that have arisen suggest that there can be lack of benefit from blood transfusions. The first suggestion is that the adverse clinical consequences of blood transfusion results from the effects of leukocytes contained in the transfused blood. The second adverse clinical consequences of blood transfusion result from prolonged blood storage, (transfusion of ‘old’ blood.) Other studies have given explanations on how the blood transfusions depress the immune function of the recipient. Evidence of the transfusion associated immune suppression emerged following observations that blood transfusions improve the renal allograft survival, as well as increased ICU and postoperative infections.

During the storage of the blood, time dependent changes occur within the storage medium, such as a progressive fall in the PH, an increase in plasma potassium and release of free hemoglobin from the red cells.

The clinical consequences of transfusing these storage by products are limited, given the capacity of the patients to dilute, buffer or remove these substances. The generation of cytokines and other bioreactive substances such as histamine, which accumulate in the storage media, causing deterioration in the quality of the red blood cells. Also, disease processes like sepsis impair the deformation of the red blood cells. (Hebert P. C, etal, 2007) Such cases can inflict fear to a patient in need of blood transfusion, and may cause him to forego the process. They may also cause the family of the patient to refuse a blood transfusion to the patient especially where there is an epidemic of a certain disease.

Relevance of blood transfusion to nurses

Tammy says in the “Minority Nurse Journal” that every three seconds, a patient is in need of blood, and every day in America, 32,000 units of red blood cells save lives. She also says that no one understands the importance of “the gift of life” more than the nurses, because they see it in their work every day: platelets being given to the chemotherapy patients, plasma to the burn victims, and the red cells to the transplant patients among others. 90 percent of the US population will need a blood transfuse by age 72, yet less than 5 percent of the eligible donors regularly donate the blood. She also says that each year, 4.5 million American lives are saved though blood transfusions. An example of a beneficiary of blood transfusion is Rebecca Mead of Geneva, Illinois, a mother of two, who says that her children would not be alive today were it not for the generosity of the blood donors. She says that her children received blood transfusion hours after their birth. Today, Rebecca’s children still need blood products, as they continue to still grow up healthy. (Basil Tammy, 2004 summer)

Biases of blood transfusion

The transfusion of red blood cells was known as the most effective and safe way to deliver oxygen to the tissues.  However, the practice has been under controversy for at least the last two decades. At first, the bias was only limited to the risk of transmitting infections and viruses from the donor to the recipient. Doctors carried out research to advance blood transfusion, which ensured a decrease in transmission of the viral infections. Today, the bias information is directed towards the transfusion practice; re-examination of the approach to RBC transfusion. Hebert, etal, of the ‘Chest journal’, gives a review of the biasness that surrounds blood transmission on the critically ill patients with a cardiac disease, severe sepsis and septic shock. He says that anemia is very common in the critically ill persons with Almost 95 percent of the patients admitted at the ICU having a hemoglobin level that is below the normal, especially on their third day at the ICU. (Hebert P. C, etal, 2007)

As a result of the anemia, the critically ill people receive a large number of RBC transfusions. The journal cites two studies that were conducted in Europe and at the U.S. The results of the studies showed that on average, the critically ill patients received almost 5 U of the RBCs. At the same time, another study conducted by the Canadian Critical Care Trial Groups gave evidence and raised questions regarding the validity of the historical assumption the RBC transfusion was beneficial for the critically ill patients with anemia. Observations made were that, conservative transfusion triggers were not associated with an increase in mortality; on average, mortality was one fifth lower with conservative compared with liberal transfusions triggers. The length of the hospital stay and cardiac mobility did not appear to be adversely affected by the lower use of the RBC transfusions. A 50% of the patients under the study had cardiovascular disease. Using the metaanalytic techniques, there were no differences in the combined odds of death or cardiac events using restrictive strategies as compared to more liberal approaches.

However, there still remains variation in the RBC transfusion practice patterns. Today, there is no convincing data to support the routine use of RBC transfusion to treat anemia in hemodynamically stable critically ill patients without evidence of acute bleeding. The data available would suggest that in the absence of acute bleeding, hemoglobin levels of 70 to 90 g/l are still tolerated by most critically ill patients and that a transfusion threshold of 70 g/l is appropriate. There is still bias regarding to what transfusion threshold is most appropriate for critically ill patients with acute ischemic cardiac disease or in the early resuscitation of the septic patient. (Hebert P. C, etal, 2007)

Conclusion

In conclusion, I would say that there is no way the world would survive without blood transfusion, not with all the people in need of blood every day. It is true that every person has a right to refuse blood transfusion, but careful consideration should be taken before making the decision not to accept transfusion. Nurses should also take it upon themselves to encourage more people to donate blood, because when they do so, they offer the “gift of life” to a person who would otherwise have died. In the case of the fear of transmission of infections from the transfusion, medical organizations need to educate the patients of the need to take the risk, despite their fears. This topic is of relevance to my career because it is educative on the issues concerning blood transfusion that a nurse faces every day. Being familiar with the issue is also a boost to my career; I now know people’s fears in refusing an blood transplant, and can explain the dangers that such a patient may be facing.