Editing Blood transfusion (section)

== Special populations ==

=== Neonate ===
To ensure the safety of blood transfusion to pediatric patients, hospitals are taking additional precautions to avoid infection and prefer to use pediatric blood units that are guaranteed "safe" from ''[[Cytomegalovirus]]''. Some guidelines have recommended the provision of CMV-negative blood components and not simply leukoreduced components for newborns or low birthweight infants in whom the immune system is not fully developed,<ref name="neonatal-CMV">{{cite web |url=http://www.cps.ca/english/statements/fn/fn02-02.htm#What%20type%20of%20RBCs%20should%20be%20used |title=Red blood cell transfusions in newborn infants: Revised guidelines |publisher=Canadian Paediatric Society (CPS) |access-date=2007-02-02 |url-status=dead |archive-url=https://web.archive.org/web/20070203095445/http://www.cps.ca/english/statements/FN/fn02-02.htm#What%20type%20of%20RBCs%20should%20be%20used |archive-date=2007-02-03 }}</ref> but practice varies.<ref name="b411">{{cite journal | last1=Reeves | first1=Hollie M. | last2=Goodhue Meyer | first2=Erin | last3=Harm | first3=Sarah K. | last4=Lieberman | first4=Lani | last5=Pyles | first5=Ryan | last6=Rajbhandary | first6=Srijana | last7=Whitaker | first7=Barbee I. | last8=Delaney | first8=Meghan | title=Neonatal and pediatric blood bank practice in the United States: Results from the AABB pediatric transfusion medicine subsection survey | journal=Transfusion | volume=61 | issue=8 | date=2021 | issn=1537-2995 | pmid=34110629 | doi=10.1111/trf.16520 | pages=2265–76}}</ref> These requirements place additional restrictions on blood donors who can donate for neonatal use, which may be impractical given the rarity of CMV seronegative donors and the preference for fresh units.

Neonatal transfusions typically fall into one of two categories:
* "Top-up" transfusions, to replace losses due to investigational losses and correction of anemia.
* Exchange (or partial exchange) transfusions are done for removal of bilirubin, removal of antibodies and replacement of red cells (e.g., for anemia secondary to [[thalassemia]]s and other [[Hemoglobinopathy|hemoglobinopathies]] or [[fetal erythroblastosis]]).<ref>{{cite journal | vauthors = Radhakrishnan KM, Chakravarthi S, Pushkala S, Jayaraju J | title = Component therapy | journal = Indian Journal of Pediatrics | volume = 70 | issue = 8 | pages = 661–6 | date = August 2003 | pmid = 14510088 | doi = 10.1007/BF02724257 | s2cid = 42488187 }}</ref>

=== Significant blood loss ===
A ''massive transfusion protocol'' is used when significant blood loss is present such as in [[major trauma]], when more than ten units of blood are needed. Packed red blood cells, fresh frozen plasma, and platelets are generally administered.<ref name=EMB11>{{cite journal | vauthors = Cherkas D | title = Traumatic hemorrhagic shock: advances in fluid management | journal = Emergency Medicine Practice | volume = 13 | issue = 11 | pages = 1–19; quiz 19–20 | date = November 2011 | pmid = 22164397 | url = http://www.ebmedicine.net/store.php?paction=showProduct&catid=8&pid=244 | url-status = dead | archive-url = https://web.archive.org/web/20120118152838/http://www.ebmedicine.net/store.php?paction=showProduct&catid=8&pid=244 | archive-date = 2012-01-18 }}</ref> Typical ratios of [[fresh frozen plasma]], [[platelets]] and [[packed red blood cells]] are between 1:1:1 and 1:1:2.<ref name="j842">{{cite journal | last1=Meneses | first1=Evander | last2=Boneva | first2=Dessy | last3=McKenney | first3=Mark | last4=Elkbuli | first4=Adel | title=Massive transfusion protocol in adult trauma population | journal=The American Journal of Emergency Medicine | volume=38 | issue=12 | date=2020 | issn=1532-8171 | pmid=33071074 | doi=10.1016/j.ajem.2020.07.041 | pages=2661–6}}</ref>

In some locations, blood has begun to be administered ''pre-hospital'' in an effort to reduce preventable deaths from significant blood loss. Earlier analyses suggested that in the US, up to 31,000 patients per year bleed to death that otherwise could have survived if pre-hospital transfusions were widely available.<ref>{{cite news |last1=Caruba |first1=Lauren |title=Bleeding Out: A new series exploring America's urgent health crisis |url=https://www.dallasnews.com/news/investigations/2023/11/27/bleeding-out-a-new-series-exploring-americas-urgent-health-crisis/#:~:text=For%20more%20than%20two%20years,shootings%2C%20falls%20and%20other%20accidents. |access-date=2023-12-21 |archive-date=2023-12-21 |archive-url=https://web.archive.org/web/20231221230728/https://www.dallasnews.com/news/investigations/2023/11/27/bleeding-out-a-new-series-exploring-americas-urgent-health-crisis/#:~:text=For%20more%20than%20two%20years,shootings%2C%20falls%20and%20other%20accidents. |url-status=live }}</ref> For example, when a mother experiences severe blood loss during pregnancy,<ref>{{cite news |last1=Villalpando |first1=Nicole |title=Whole blood program saves Cedar Park mom's life |url=https://www.statesman.com/videos/news/healthcare/2023/11/09/whole-blood-program-saves-cedar-park-moms-life/71517999007/ |access-date=2023-12-21 |archive-date=2023-12-21 |archive-url=https://web.archive.org/web/20231221230728/https://www.statesman.com/videos/news/healthcare/2023/11/09/whole-blood-program-saves-cedar-park-moms-life/71517999007/ |url-status=live }}</ref> ambulances are able to arrive with blood stored in portable, FDA listed blood refrigerators, similar to those found in blood banks. Once the infusion is given on scene, the patient and the ambulance have more time to get to a hospital for surgery and additional infusions if needed. This could be critical in rural areas or sprawling cities where patients can be far from a major hospital and the local emergency medical team may need to use blood infusions to keep that patient alive during transport.  Larger studies pointed to improvements in 24-hour mortality with pre-hospital plasma and RBC transfusions, but no difference in 30-day or long-term mortality.<ref name="t572">{{cite journal | last1=Rossaint | first1=Rolf | last2=Afshari | first2=Arash | last3=Bouillon | first3=Bertil | last4=Cerny | first4=Vladimir | last5=Cimpoesu | first5=Diana | last6=Curry | first6=Nicola | last7=Duranteau | first7=Jacques | last8=Filipescu | first8=Daniela | last9=Grottke | first9=Oliver | last10=Grønlykke | first10=Lars | last11=Harrois | first11=Anatole | last12=Hunt | first12=Beverley J. | last13=Kaserer | first13=Alexander | last14=Komadina | first14=Radko | last15=Madsen | first15=Mikkel Herold | last16=Maegele | first16=Marc | last17=Mora | first17=Lidia | last18=Riddez | first18=Louis | last19=Romero | first19=Carolina S. | last20=Samama | first20=Charles-Marc | last21=Vincent | first21=Jean-Louis | last22=Wiberg | first22=Sebastian | last23=Spahn | first23=Donat R. | title=The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition | journal=Critical Care | volume=27 | issue=1 | date=2023-03-01 | pmid=36859355 | pmc=9977110 | doi=10.1186/s13054-023-04327-7 | doi-access=free | page=80}}</ref>

=== Unknown blood type ===
Because [[blood type]] O negative is compatible with anyone, it is often overused and in short supply.<ref name="AABBfive-5">{{Citation |author1 = American Association of Blood Banks |author1-link = American Association of Blood Banks |date = 24 April 2014 |title = Five Things Physicians and Patients Should Question |publisher = American Association of Blood Banks |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-association-of-blood-banks/ |access-date = 25 July 2014 |archive-url = https://web.archive.org/web/20140924075027/http://www.choosingwisely.org/doctor-patient-lists/american-association-of-blood-banks/ |archive-date = 24 September 2014 |url-status = dead }}, which cites
* {{cite web|author1=The Chief Medical Officer's National Blood Transfusion Committee|title=The appropriate use of group O RhD negative red cells|url=http://hospital.blood.co.uk/library/pdf/nbtc_bbt_o_neg_red_cells_recs_09_04.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://hospital.blood.co.uk/library/pdf/nbtc_bbt_o_neg_red_cells_recs_09_04.pdf |archive-date=2022-10-09 |url-status=live|publisher=[[National Health Service]]|access-date=25 July 2014|year=c. 2008}}</ref> According to the  [[AABB|Association for the Advancement of Blood and Biotherapies]], the use of this blood should be restricted to persons with O negative blood, as nothing else is compatible with them, and women who might be pregnant and for whom it would be impossible to do blood group testing before giving them emergency treatment.<ref name="AABBfive-5" /> Whenever possible, the AABB recommends that O negative blood be conserved by using blood type testing to identify a less scarce alternative.<ref name="AABBfive-5" />

=== Religious objections ===
[[Jehovah's Witnesses and blood transfusions|Jehovah's Witnesses may object to blood transfusions]] because of their belief that blood is sacred.<ref>{{Cite book|url=https://books.google.com/books?id=cGBaz0hp_fcC&pg=PA279|title=Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects|vauthors=Hillyer CD, Shaz BH, Zimring JC, Abshire TC|year=2009|publisher=Elsevier|isbn=978-0-08-092230-0|page=279|access-date=2017-09-04|archive-date=2024-07-26|archive-url=https://web.archive.org/web/20240726172745/https://books.google.com/books?id=cGBaz0hp_fcC&pg=PA279#v=onepage&q&f=false|url-status=live}}</ref>

=== Personal objections ===
Sometimes people refuse blood transfusions because of fears about the safety of the blood supply.<ref name=":6" />  Generally speaking, the rules of [[informed consent]] allow mentally [[Competence (law)|competent]] adults to refuse blood transfusions even when their objections are based on [[misinformation]] or [[prejudice]] and even when their refusal may result in serious and permanent harm, including death.<ref name=":6" />  For example, since [[COVID-19 vaccine|COVID-19 vaccines]] became available, some people have refused blood transfusions because the donor might have been vaccinated, and they [[Vaccine_hesitancy#Blood_transfusion|fear that this would cause secondhand harm to them]].<ref name=":6" />  This choice is based on false beliefs, but a mentally competent adult's choices are normally respected.<ref name=":8">{{Cite journal |last1=Kim |first1=Daniel H. |last2=Berkman |first2=Emily |last3=Clark |first3=Jonna D. |last4=Saifee |first4=Nabiha H. |last5=Diekema |first5=Douglas S. |last6=Lewis-Newby |first6=Mithya |date=2023 |title=Parental Refusals of Blood Transfusions from COVID-19 Vaccinated Donors for Children Needing Cardiac Surgery |url=https://pubmed.ncbi.nlm.nih.gov/38661995 |journal=Narrative Inquiry in Bioethics |volume=13 |issue=3 |pages=215–226 |doi=10.1353/nib.2023.a924193 |issn=2157-1740 |pmid=38661995}}</ref>  However, if doctor's opinions are that parents and guardians are making harmful choices about children, they can be overruled (in some jurisdictions) using legal arguments based on the [[harm principle]]; in this case if doctors believe that refusing the blood transfusion would put the child at risk of serious injury or death.<ref name=":8" />  Blood banks do not collect information that is irrelevant to the transfusion process, including the donors' race, ethnicity, sexual orientation, COVID-19 vaccination status, etc., so selecting blood units based on the individual's personal objections is not practical.<ref name=":6" /><ref name=":8" />