Blood transfusions are essential medical interventions to replace lost blood, treat certain medical conditions, and improve patient outcomes. While blood transfusions are generally safe and effective, in some cases they may not be the best medical course of action or are not advisable for other reasons. 

What is a blood transfusion?

Transfusion can be termed as transferring blood from one person (donor) to another (recipient). The essential purpose of a blood transfusion is to cover or compensate for lost blood. In some cases, this method provides additional blood components to the immune-suppressed person, which becomes necessary for their body’s normal functioning.

In a blood transfusion, blood is taken from a donor’s arm and administered to the recipient’s body through an intravenous (IV). 

Blood transfusions can be lifesaving in critical case scenarios, like when a person has lost significant blood due to injury, surgery, or a medical condition such as anemia or cancer. However, despite the importance of blood transfusions, like all other medical procedures, blood transfusions also carry some risks, including allergic reactions, infection, and transfusion-related lung injury. Transfusable blood may also be unavailable, especially in times of high demand such as pandemics and disasters, or where safe storage is not possible.

Blood should be carefully examined for any infectious agents and other potential microorganisms before transfusing to decrease the risks associated with transfusions. Healthcare providers should also closely monitor donors and recipients during and after transfusions to watch for any side effects.

Religious concerns

Some religions prescribe blood transfusions on ethical or moral grounds. Religious contradictions occur from the beliefs and teachings of religious groups that prohibit blood consumption and the use of blood.

What are common concerns related to blood transfusion in a patient?

Blood transfusions can have possible side effects in patients, especially those with underlying health conditions.

ABO Blood Type Incompatibility

 One of the most crucial and common contradictions is when the blood types of the donor and recipient do not match. For example, a person with blood type A receives blood from someone with blood type B. This triggers the recipient’s immune system, which may recognize the transfused blood as foreign and produce an immune response. This can result in a bad reaction called a transfusion reaction.

Transfusion-related acute lung injury (TRALI)

 TRALI is a rare but severe side effect of blood transfusion. It can be referred to as acute respiratory distress; In other words, it is an immune response to transfused blood components.


Blood transfusions highly carry the risk of disease. Infection can be of special concern for elderly patients with weakened immune systems. The risk of developing an infection can be minimized by carefully testing the donor’s blood.

Antibody Development

 Initial exposure to typical antigens can result in the development of antibodies in the receiver blood. If these antibodies react with antigens in the body, they cause a transfusion reaction. For example, if a woman has previously been introduced to a particular antigen through pregnancy or previous transfusions, receiving blood with that antigen can lead to complications.

Fluid overload/hypervolemia

 This condition may affect many people, but older people are more susceptible to fluid overload. It is referred to as hypervolemia. Fluid overload is a condition in which edema occurs. This condition can lead to congestive heart failure or pulmonary edema (edema in the lungs).

Hemolytic reactions

Hemolytic reactions are transfusion reactions that occur when the receiver’s immune system attacks and destroys transfused blood’s red blood cells. Hemolytic reactions are rare but life-threatening, especially febrile no hemolytic reactions.

Febrile nonhemolytic reactions (FNHTR)

These are the worst transfusion reactions that occur during or shortly after a blood transfusion. FNHTR is an immune-mediated reaction. It is caused by the receiver’s antibodies reacting to blood cells or platelets in the transfused blood.

What are prevention and management steps to minimize transfusion risks? 

There are many ways to prevent and manage complications during a blood transfusion. 

Careful patient selection

 Before transfusing blood, healthcare providers or hospital setups should carefully assess a donor’s medical history and overall health status to minimize any risk factors contributing to developing infections.

Use of compatible blood

To decrease the risk of transfusion reactions, healthcare providers should assure that the transfused blood is consistent with the patient’s blood type and other medical conditions.


During the transfusion, healthcare providers should monitor the patient for signs of complications, such as fever, chills, and shortness of breath. Vitals should also be monitored before and after, and during transfusions.

Hydration and electrolyte management

Blood transfusions can sometimes lead to fluid overload or imbalances, specifically in older adults with underlying chronic diseases. Adequate hydration and electrolyte management can help prevent this condition.


If the patient is assessed thoroughly, healthcare providers may prescribe some medications to minimize the risk of transfusion reactions and other complications.

Smaller transfusion volumes

Older people are more susceptible to volume overload, so that smaller transfusion volumes may prevent this risk.

Post-transfusion monitoring

Healthcare providers must monitor the patient for any sign of complication, such as fever or infection, after the transfusion.

Treating complications

If complications occur, adequate treatment can help to minimize the risk of turning problems into chronic conditions. Treatment may include giving medications to manage symptoms, additional blood transfusions, or other immediate medical help.


In conclusion, blood transfusions can be effective for many patients. However, there are times when they are not advisable. Side effects are possible, especially for immune-depressed people and elderly having underlying health conditions. Transfusion reactions can occur in any person, and common transfusion reactions in the elderly include hemolytic reactions, febrile nonhemolytic reactions, transfusion-related acute lung injury, etc.

To manage and minimize the risks associated with transfusions, healthcare providers must carefully assess the patient’s medical history before transfusing blood. Taking steps such as using compatible blood products, monitoring the patient closely for signs of complications, and managing electrolyte imbalances effectively prevent complications. Objections to transfusions may also be driven by a person’s religious beliefs. Finally, transfusable blood can be in short supply and unavailable in times of great demand, or where storage is not available.

Dr. Irfan Siddique is a GMC-registered Medical Doctor with more than four years of post-graduation experience in child and adolescent healthcare. He has done his Bachelor of Medicine and Bachelor of Surgery (MBBS) from the University of Health and Sciences, Lahore. Afterward, he was positioned at Children’s Hospital, Faisalabad, where he ran Outpatient Department for four years. Currently, he is performing his duties as Medical Doctor at St. Barts Health NHS Trust, London.