Blood Transfusions: Extra Steps Ensure Safety

The team at Yale Medicine takes extra steps to ensure that each drop of blood reaching patients exceeds national quality standards.

Quick facts about blood safety at Yale Medicine
  • Blood is screened for HIV, Hepatitis B and C, syphilis, West Nile virus, Human T-Lymphotropic Virus (HTLV) I and II, and bacterial contamination.
  • Yale Medicine only uses blood that is tested and found negative for the Babesia organism that’s spread by tick bites.
  • The risk of contracting a virus such as HIV or Hepatitis C from a blood donation is about 1 in 2 million–lower than your risk of being struck by lightning, according to the NIH.
  • Full-time transfusion service directors make sure that blood safety meets and exceeds national standards.
  • A brand-new development in blood technology will soon allow blood centers to eliminate Zika and many other viruses and contaminants from the blood supply.

Each year some 5 million Americans receive a blood transfusion, a life-saving procedure to replace blood lost after surgery, serious injury, childbirth or illness. But with concerns about the spread of viruses such as Zika and lingering fears about HIVhepatitis and other blood-borne viruses and pathogens, a patient may wonder: How do I know the blood flowing into my arm is safe?

Rest assured, says Edward Snyder, MD, professor of laboratory medicine at Yale Medicine and director of the Blood Bank at Yale New Haven Hospital. Before any unit of A, B, AB or O blood is infused, it is put through a rigorous series of screenings.

“Yale is devoted to giving you the safest possible blood,” Dr. Snyder says. “We get our blood supply from two accredited blood centers—the American Red Cross and the Rhode Island Blood Center—where it’s fully tested in accordance with all Food and Drug Administration requirements. And then we monitor it here as well, so we know the patients are getting the safest possible blood for transfusion.”

A trusted, tested source

The first safety check comes at the blood donor center. Potential donors are screened for health, age, weight, recent travel history—to know, for example, whether a donor has visited a country where the Zika virus is rampant—and other factors that help determine whether they are healthy enough to donate blood. At the same time, the center must follow regulations about how long the blood donation process can take, how long the blood can safely remain unrefrigerated and the temperature at which it must be stored, Dr. Snyder says. Blood is identified by ABO and Rh type, then labeled with a barcode to track it through the screening system.

Next, the blood is put through a series of tests mandated by the FDA and the American Association of Blood Banks. Each unit is screened for HIV 1 and 2, Hepatitis B, Hepatitis C, syphilis, West Nile virus, Human T-lymphotropic virus (HTLV) I and II and bacterial contamination. A test for the Zika virus has also been mandated by the FDA.
Connecticut also tests for the Babesia organism, which is spread by ticks and which Dr. Synder says is “endemic in this area.” The parasite causes babesiosis, a disease with symptoms similar to malaria.

A new development in blood technology will soon allow blood centers to eliminate Zika and many other viruses and contaminants from the blood supply. The FDA recently approved this critical new advance, called pathogen reduction.
“In this process, certain chemicals are added to the blood, which is then exposed to UVA [ultraviolet A] light, binding the chemical to the DNA or RNA of any virus, bacteria or protozoa and preventing it from replicating,” Dr. Snyder says. This eliminates harmful pathogens that may not have been detected during the screening process, while protecting the needed components of the blood such as platelets and plasma, which do not contain any DNA or RNA.

Blood safety first

While blood received at any hospital in the United States goes through the same initial screenings, patients at Yale Medicine have the added benefit of knowing that there is a staff of full-time transfusion service directors. These professionals are dedicated to making sure that blood safety within the hospital not only meets but exceeds national standards. The team monitors each unit of blood from the time it arrives at Yale New Haven Hospital—a process that continues even after the transfusion, to check for any adverse reactions.

 “We have four full-time blood bank directors at Yale, plus residents, fellows, a transfusion safety officer and a compliance officer, so there is always staff available to monitor the safety of the blood supply 24/7,” says Dr. Snyder.
The Yale Blood Transfusion Service is accredited and inspected by many organizations, including the FDA, the Joint Commission, the College of American Pathologists, AABB (formerly the American Association of Blood Banks), the American College of Surgeons and the Connecticut Board of Health. An outside inspector visits the transfusion service every few months.

Some people develop a fever or even allergies to blood after a transfusion, though those are rare complications that can be treated with antihistamines, if necessary. “When this happens, we do an investigation and an analysis to figure out what happened and determine the corrective action,” Dr. Snyder says. The National Institutes of Health reports that the risk of contracting a virus such as HIV or Hepatitis C from a blood donation is about 1 in 2 million—lower than your risk of being struck by lightning (1 in 750,000).

A key goal: Avoiding transfusion

Dr. Snyder says one goal of the Yale Blood Bank staff and the doctors at Yale Medicine is to make sure patients do not need to use the blood bank services in the first place.

“We focus a lot on patient blood management, trying to prevent people from needing any blood transfusions by minimizing blood loss and optimizing the use of their own blood,” he says. “Just as we are passionate about giving the right unit of blood to the right patient for the right reasons, there is a huge passion for making sure a patient who doesn’t need blood doesn’t get it just because it’s there. After all, the safest unit of blood is the one you don’t get.”