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What is anaemia?
Anaemia is a condition where the amount of haemoglobin in the blood is below the normal
level, or there are fewer red blood cells than normal.
There are several different types of anaemia and each one has a different cause, although
iron deficiency anaemia is the most common type. Iron deficiency anaemia occurs when
there isn't enough iron in the body. Iron is found in meat, dried fruit and some vegetables.
Iron is used by the body to make haemoglobin, which helps store and carry oxygen in red
blood cells. This means if there is a lack of iron in the blood, organs and tissues will not get
as much oxygen as they usually do. In women of reproductive age, the most common
causes of iron deficiency anaemia are heavy periods and pregnancy (because your body
needs extra iron for your baby).
In pregnancy, the body makes extra red blood cells to cope with the demands of the baby
as well as those of the mother. Despite this, mild anaemia is common during pregnancy
and your haemoglobin level will be routinely checked at your first pregnancy appointment
and at 28 weeks.
In a non-emergency situation
You may be offered a blood transfusion in a non-emergency situation when:
You have moderately severe anaemia in late pregnancy. there is a risk that, if you
bleed even a small amount during birth, you may become severely anaemic.
You have a blood condition, such as sickle cell disease or thalassaemia; it affects your
bodys ability to produce healthy haemoglobin. You have an increased risk of
developing severe anaemia when you become pregnant.
You have anaemia immediately after birth, you may be offered a blood transfusion,
depending on your symptoms.
Data taken from Blood Transfusion Medicine by Fiona Regan and Clare Taylor, published in the British
Medical Journal, vol 325, p143.
The safety steps taken by the National Blood Transfusion Service to minimise risk start when
they check every would-be blood donor. Certain people are not allowed to give blood, most
obviously those with the infections listed in the table.
Each unit of blood is checked for the infections listed above and about half of the white
blood cells are removed. The reason for this is that it is believed that conditions like variant
CJD and other new infections just might be carried on the white blood cells, but it is not
possible to remove all these white cells at present.
When a transfusion is prescribed for you, the cells needed are the RED blood cells which carry
oxygen, not white ones. In some cases, other blood components may be prescribed, such as
plasma. This product contains only clotting agents, and again, no white cells.
Rhesus disease, which can cause severe anaemia in unborn babies, is prevented by giving
rhesus NEGATIVE mothers an injection of anti-D. This is sometimes given during pregnancy,
and is always given after the birth of a rhesus positive baby to these women. This injection
does not contain any white blood cells and is checked for the infections listed in this
information sheet.
Further information can be found at: http://www.blood.co.uk.
During a transfusion
A cannula (small tube) is placed into a vein in your hand or arm. The tube is attached to a
drip and donor blood flows through the drip. Blood for transfusion is stored in small plastic
bags containing a unit of blood which is about a third of a litre. Each unit of blood takes
about three hours to transfuse. In an emergency, blood may be transfused more quickly.
You must be correctly identified prior to the transfusion, so will be asked to state your
name and date of birth. This information will be checked against your identification band.
You are carefully monitored before and during the transfusion. Your midwife will take your
blood pressure, temperature and heart rate during the transfusion.
Some people get mild side effects, such as headaches, chills and fever, a rash and
itchiness. These symptoms are relieved by drugs, such as paracetamol, and will improve
within a day or so.
Very rarely, there may be more severe side effects, including difficulty in breathing, severe
headaches and a sudden fall in blood pressure which can be life threatening. If you get
side effects, the transfusion will be stopped immediately and the situation reviewed.
After a transfusion
Once all the blood has been transfused, the drip is taken down. Your haemoglobin level
will be re-checked to make sure that you have had received enough blood. Most women
do not need another transfusion.
If the blood transfusion is done because of an emergency, you will need to stay in hospital
overnight and sometimes for some days afterwards. The length of time will depend upon
your situation.
Should the need for a blood transfusion arise, your doctors will respect your wishes. Other
options will be discussed but, in some cases, a blood transfusion may be the only effective
treatment to save your life.
You can change your mind at any point about the use of blood. You should not feel as
though you have to stick rigidly to your original decision. Unforeseen circumstances
sometimes influence events, resulting in previous decisions needing to be changed.
Replacing your own lost blood back into your bloodstream (cell salvage)
If you have had a caesarean delivery, the doctor may be able to collect the blood lost and
replace this back into your bloodstream. Trained staff and specialist equipment are
required for this, which may not be available in your hospital at all times.
Useful links
National Blood Service for England and Wales www.blood.co.uk
Receiving a Transfusion, NHS Scotland
http://www.scotblood.co.uk/site/pubdocs/Receiving%20a%20Transfusion.pdf
Food Standards Agency www.eatwell.gov.uk.
This information has been developed by the Patient Information Subgroup of the RCOG
Guidelines Committee, with input from the Consumers Forum and the authors of the
clinical guideline.
This document can be made available in other languages and formats upon
request.
MAT_0010
Author: Linda Rough (Antenatal Services Manager) October 2009, Jane Siddall (Consultant
Obstetrician) July 2003
Approved: Maternity Information Group & Patient Information Manager, May 2015
Reviewed: December 2012, May 2015 (authors & T Hawkins (Blood Transfusion Nurse
Specialist)
Review due: June 2017