What You Need to Know About Blood Transfusions in Cancer Treatment

Blood transfusions are a common and vital part of supportive care for some people living with blood cancers. They help manage the low blood cell counts caused by the disease itself or by treatments such as chemotherapy. Transfusions can help restore blood levels and relieve symptoms such as fatigue, shortness of breath, and bleeding.

What is a blood transfusion?

A transfusion involves receiving donated blood or blood components through an intravenous (IV) line into a vein. Blood collected from volunteer donors is separated into its components so people receive only what they need. For example, platelets, red blood cells or granulocytes (a type of white blood cells).   

Why do people with cancer need blood transfusions?

There are many different reasons why a person with cancer would need a blood transfusion. There are different types of blood transfusions that can help with different problems.

The bone marrow produces three types of blood cells: 

• Red blood cells. These cells are also called erythrocytes. Red blood cells transport oxygen and nutrients to the organs. 
• White blood cells. These cells are also called leukocytes. White blood cells are part of the immune system. They help protect the body from harmful organisms such as bacteria, viruses, and parasites. 
• Platelets. These are cell fragments that are also called thrombocytes. They are formed when pieces of large cells called megakaryocytes break off. Although they are not considered cells, they play a crucial role in the wound-healing process. They protect the blood vessels from mild damage and prevent the blood from leaking.

What is a packed red blood cell transfusion?

Red blood cells carry oxygen throughout the body. When these cells are low, a condition called anemia occurs. Anemia is found by measuring a protein found in red blood cells called hemoglobin. The normal range for hemoglobin is 12 to 18 g/dL. If your hemoglobin is less than 8 g/dL, you may need a transfusion of red blood cells.

Anemia can happen because of blood loss, decreased red blood cell production, or a breakdown of red blood cells. It is a common symptom of blood cancers. 

When a transfusion is needed to replace red blood cells, it is called a packed red blood cell transfusion. This is when red blood cells are separated from other types of blood cells.  A red blood cell transfusion helps improve energy, concentration, and breathing.

What is a platelet transfusion?

Platelets help stop bleeding by forming clots. A low platelet count is called thrombocytopenia. It can cause bleeding, bruising, dots on the skin, blood in urine and stools, and unusually heavy periods. Normal platelet counts are between 150,000 to 400,000 platelets per microliter (mcL) of blood. When a platelet transfusion is needed depends on certain factors.  

People with blood cancers often experience low platelet counts because their bone marrow cannot produce enough. Platelet transfusions are used to prevent or control bleeding.

What is a plasma transfusion?

Plasma is the liquid part of blood. It contains proteins that help stop bleeding called clotting factors. Plasma transfusions may be needed during active bleeding or when clotting factors are reduced. Other plasma-derived products, such as immunoglobulins, are used for specific immune or bleeding problems.

How blood transfusions are matched and tested

Before any transfusion, your blood type (A, B, AB, or O) and Rh factor (positive or negative) are tested to make sure you can receive the donated blood. Donated blood is screened for infections such as hepatitis and HIV, making transfusions extremely safe. Identification details, such as your name and date of birth, are checked multiple times before the transfusion begins.

What happens during a blood transfusion?

A small plastic tube (cannula) is inserted into a vein. The length of the transfusion depends on the type of blood product you are getting. Blood and packed red blood cell transfusions take between 2 to 4 hours. Platelet and plasma transfusions take around 30 minutes. 

During the transfusion, your pulse, temperature, and blood pressure are checked at intervals to make sure everything is proceeding safely. Most people experience no noticeable changes during the transfusion, although mild fatigue or chills may occur. If any discomfort occurs, people are advised to tell staff if they feel unwell.

What are the risks and side effects of blood transfusions

Modern transfusion practices have significantly reduced complications. The most common reactions are mild, such as a low-grade fever or rash. Less frequent reactions include allergic responses and shortness of breath due to fluid overload. 

Some people may experience calcium alteration because of the citrate in blood packets. Citrate is an agent used to preserve blood and avoid clotting, however it can be metabolized in the body and in rare occasions cause low calcium levels. 

If transfusions are frequent, iron overload may occur, however it can be treated with iron chelation therapy that helps reduce this symptom burden. For people with MDS, it could help reduce transfusion frequency. 

Extremely rare risks include transfusion-related acute lung injury (TRALI) or receiving the wrong blood type, which hospitals prevent through strict protocols.

How is patient safety in transfusions ensured?

Before a transfusion, your healthcare team will explain why it is recommended, what alternatives exist, and what risks are involved. You will be asked to give consent after your questions are answered. If there’s an emergency and consent cannot be obtained in advance, your team will explain the procedure as soon as possible.

Patients play a role in ensuring safety by checking their name and date of birth on blood labels and forms.

Frequently Asked Questions (FAQ) 

• Will I feel different after a transfusion?

 Most people feel better as symptoms like fatigue or dizziness improve. Some may feel tired afterward, which usually resolves quickly.

• Can transfusions cause long-term problems?

 There are few known long-term effects. Inform your care team if you’ve had transfusions before, as this may affect future matching.

• Can a family member donate blood to me?

In most cases, no. Blood from screened voluntary donors is safer and more consistent than directed donations from relatives.

Are there alternatives to blood transfusions? 

Blood transfusions are the fastest way to restore the blood cell levels back to normal. However, there are modern alternatives to blood transfusion, such as IV iron, vitamins, and red blood cell–stimulating medications, which focus on correcting the underlying cause of anemia and supporting the body’s natural blood production. By addressing nutrient deficiencies and inflammation early, patients can maintain healthier blood levels and reduce exposure to transfusions.

It’s important to note that not all people diagnosed with blood cancers are eligible for these types of treatments, since some blood cancers generate more defective blood cells and stimulating the production is not the best way to address the lack of healthy blood cells.  

Erythropoiesis-stimulating agents (ESAs)

These medications can help the body produce more red blood cells. They mimic erythropoietin, the natural hormone made by the kidneys. However, studies have shown that using high doses of ESAs to achieve normal hemoglobin levels may increase the risk of blood clots and other complications. To avoid complications, guidelines recommend using the lowest effective dose to reduce transfusion needs while keeping hemoglobin levels safe.

Iron-restricted erythropoiesis and IV iron therapy

Even when iron stores are normal, some people may experience functional iron deficiency, meaning the iron is not released from storage due to high hepcidin levels or rapid red blood cell production. This can occur in chronic inflammation, cancer, or dialysis. In such cases, IV iron has been shown to improve response to ESAs and raise hemoglobin levels more effectively than oral iron. For patients who do not tolerate oral iron or do not respond to treatment, IV iron provides a valuable, safe alternative that avoids transfusion.

Balancing benefits and risks or rejecting transfusions

While these approaches can effectively reduce transfusion needs, each treatment has its own safety considerations. The increased risk of thrombosis (blood clots) from ESAs and the potential for allergic reactions with IV iron require careful monitoring. Treatment decisions should always be individualized, taking into account the patient’s condition, symptoms, and risk factors.

How blood donation makes a difference for people with cancer

Donated blood is a shared resource that supports people with blood cancers, surgery, and other medical needs. Every donation can save or improve multiple lives. Encouraging friends and family to donate can help ensure that safe blood remains available for everyone. If you are healthy and have a desire to help others, donating blood once a year may change a person’s life. 

Depending on the type of blood cell being donated, one person can donate up to 13 times a year. If you want to learn more about the requirements for donating blood, you can visit The American Red Cross website. 

Blood transfusions are a supportive treatment that helps people with blood cancers improve their health and quality of life. Knowing what to expect and understanding your role in the process can make the experience less stressful. 

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Sources: 

• Alternatives to blood transfusion
• Blood 101: What is Blood & Why it Matters