Blood Transfusion

Countless lives have been saved since blood transfusions were first introduced in the seventeenth
century. Initially, some members of the medical community were hesitant to use them, but
transfusions were soon seen as vital in the replenishment of blood lost through trauma, illness or in
the operating theatre. In many ways, transfusions are a medical marvel, providing a safety net for
times when procedures don’t quite go according to plan. Transfusions also represent a lifeline for
people with inherited blood disorders, with certain rare diseases or who are undergoing
chemotherapy. But the field of transfusion medicine is changing. Instead of seeing it as an inert
recharging of fluid, we’re now coming to appreciate that a blood transfusion is essentially a liquid
‘organ transplant’, which comes with its own risks and drawbacks.

Blood occupies a strange and somewhat privileged position in modern medicine, and it has evolved
as a treatment option without the same level of research scrutiny – at least on the patient outcomes
side of things – that other treatments are subjected to. Nowadays, if you have a modern
pharmaceutical it goes through the whole process of clinical trials before it's registered, but blood
didn't come to health that way. As far back as 1990, studies were hinting that blood transfusions
carried more risks than had previously been thought, and it was quickly becoming apparent that the
mere fact a patient received a blood transfusion was a risk factor and in some instances was
associated with poorer outcomes.

Research up to now has been far from comprehensive. ‘Restrictive transfusion’ studies – where a
transfusion was only given if a patient’s haemoglobin levels dropped to a certain point – did not
appear to leave the patient any worse off. In a perfect world, however, scientists would do a clinical
trial. People would be randomly assigned to one of three groups – some would have a blood
transfusion, others would be given a placebo and others no transfusion at all. Scientists would then
compare how each group fared. But a trial such as this would never get approved, because why
would you give a blood transfusion to someone who didn't need one, even in a clinical trial setting?
By the same token, why risk not giving blood to someone who might well die without it?
Another way of testing the pros and cons of blood transfusion involves consent. Fully informed
patients are well within their rights to refuse a blood transfusion if they feel it conflicts with cultural,
religious and personal beliefs. Such patients have inadvertently served as a sort of test case. This
situation, in which transfusion is no longer an option for doctors, has given rise to some surprising
results when the patient makes a better than expected recovery following surgery. Some
commentators have suggested that the option of transfusion being unavailable may have led
surgeons to proceed in a more cautious manner, which resulted in positive changes in surgical
technique that led to improved outcomes. Another interpretation, however, could be that the
transfusion itself was doing more harm than good.

When it comes to extracting and identifying the negative consequences of blood transfusion,
medical researchers still have a challenge ahead of them. The reason is that if someone is considered
sick enough to need a transfusion, there's a good chance they're already in a bad way physically. This
makes it virtually impossible for anyone to say with any degree of conviction that a patient's state of
health is caused by the blood transfusion or is the result of the illness and trauma that led to them
receiving the blood transfusion in the first place. What is known is that the observational studies
have pointed to a longer time spent in hospital, a higher risk of infection after surgery, an increased
likelihood of needing artificial ventilation, and a greater risk of needing transfer to the Intensive Care
Unit with conditions such as multi-organ failure. Such evidence is tenuous to say the least, and
therefore the jury is still out.

A growing body of research data from laboratory and animal studies is giving insights into what
transfused blood does to the host body. Take the fact that blood transfusions were once used to
prepare recipients for kidney transplant, because transfusions were known to reduce the likelihood
that the host immune system would reject the donor organ. This suggests that donor blood is
somehow modifying the host's immune system; a desirable effect in the early days of kidney
transplants, but less desirable if a patient is in intensive care after an accident and already physically
vulnerable.

There's also the suggestion that the more blood a patient gets, the more problems they are likely to
have. However, even one unit of blood is enough to cause problems, so such concerns may be
misplaced. More significant is the fact that storing donated blood outside the body changes it.
Chemical messengers called cytokines, and other biological substances, accumulate in stored blood,
and there’s the possibility that this may cause issues when the blood is transfused into the patient.
1. In the first paragraph, the writer makes the point that blood transfusion

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A has an impressive range of functions.

○
B is needed now more than ever before.

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C was developed primarily for use during surgery.

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D hasn’t always been regarded as a suitable treatment.

2. In the second paragraph, the writer is suggesting that the benefits of blood transfusion

○
A can be outweighed by unreported negative factors.

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B need to be confirmed by further critical investigation.

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C have been conclusively established in most medical contexts.

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D may not always guarantee that it’s the safest treatment option.

3. In the third paragraph, what point is made about research into blood transfusions?

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A It hasn’t tended to attract sufficient financial resources.

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B Approval for a full clinical trial has been repeatedly withheld.

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C It hasn’t been possible to follow accepted scientific principles.

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D Studies done to date are thought to be adequately representative.
4. In the fourth paragraph, it is suggested that patients who opt not to have a blood
transfusion

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A may have encouraged the development of surgical skills.

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B have been identified as a source of data for ongoing studies.

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C have provided evidence for the general benefits of the procedure.

○
D have stimulated some heated debates amongst medical professionals.

5. In the fifth paragraph, the word ‘this’ refers to

○
A the negative consequences of transfusion.

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B the decision to give a patient a transfusion.

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C the challenge of doing research into transfusions.

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D the state of health of a patient receiving a transfusion.

6. The writer uses the phrase ‘the jury is still out’ in the sixth paragraph to stress that
negative outcomes of transfusions

○
A are likely to vary in different contexts.

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B are rarely due to the procedure alone.

○
C are difficult to isolate with any certainty.

○
D are often wrongly attributed to the procedure.
7. In the sixth paragraph, the writer mentions blood transfusions during kidney transplants
as an example of

○
A a use of transfusions that has now been questioned.

○
B an unexpected benefit of transfusions that has come to light.

○
C a mistaken assumption about transfusions that has been corrected.

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D an area where non-human studies have led to new uses for transfusions.

8. In the final paragraph, the writer highlights a problem regarding

○
A how often a patient receives donated blood by transfusion.

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B the length of time donated blood is stored prior to transfusion.

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C how donated blood is stored before it is needed for transfusion.

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D the quantities of donated blood transfused to a patient over time.
Key

1. A
2. B
3. C
4. A
5. D
6. C
7. A
8. C