Feature Articles

Treating Anemia with Red Blood Cell Transfusions

January 20, 2010

Anemia, the Blood and Transfusions

Anemia is a condition of lower than normal levels of healthy red blood cells circulating in the blood stream. The severity of anemia is measured by a person’s hemoglobin level or hematocrit level. Hemoglobin is a component of the red blood cell that carries oxygen to different tissues and organs throughout the body. A patient’s hemoglobin level can drop for several reasons, including nutritional problems, infections, chronic diseases, menstruation, blood loss, or surgery, to name a few. See the several Information Handouts which explain some of these various causes. Patients can also become anemic due to genetic reasons which are explained further in the article Hereditary Causes of Anemia.

Treatments for anemia are also varied and which one is right for you depends on what is causing the anemia. In many cases of mild or moderate anemia, treating the underlying condition will be enough to get hemoglobin levels rising again. Patients with mild or moderate anemia may not have any anemia-related symptoms or only a few signs of tiredness. However, when anemia becomes severe – generally when hemoglobin drops to or below 7-8 g/dL – transfusions are often used to quickly raise hemoglobin levels to a normal range and reduce symptoms like significant fatigue and dizziness.

Treating Anemia with Transfusions

Anemia is common in patients who have experienced major blood loss from physical trauma, those who are chronically ill, or those who have recently undergone major surgery.1 Blood transfusions are common in these settings and may save lives by quickly increasing a patient’s blood volume and raising the hemoglobin level. Although transfusions can provide such immediate benefits, many different types of patients are transfused based on hemoglobin values, rather than symptoms.

Blood transfusions, however, do come with some risks. For instance transfused blood can introduce pathogens directly into the blood stream, can lead to possibly fatal reactions, or can cause changes in the patient’s immune system that may lead to other serious reactions and infections. Additionally, several studies have shown that patients who receive transfusions, on average, stay in the hospital longer, have higher hospital bills, and are generally more ill than patients who did not receive a transfusion.2 Some studies have even shown a greater likelihood of death in extensively transfused patients.3

Anemic Ranges of Hemoglobin
and Hematocrit Values
Sex/Age (yrs) Hemoglobin (g/dL) Hematocrit (%)
Children (0.5-4) < 11.0 < 33
Children (5-12) < 11.5 < 35
Children (12-15) < 12.0 < 36
Adult Men < 13.0 < 39
Non-pregnant Women < 12.0 < 36
Pregnant Women < 11.0 < 33
WHO. Worldwide Prevalence of Anaemia 1993-2005.7
*These are only guidelines and some physicians feel the thresholds should be higher for adults.

Due to these risks, it is important to talk to your doctor about any possible blood transfusions you may need to treat anemia. “Anemic patients should know that they have a right to speak up and a need to speak up when it comes to transfusions,” advises Dr. Richard K. Spence, a surgeon and past president of the Society for the Advancement of Blood Management (SABM). In this effort to discuss transfusions with your doctor, SABM provides a helpful list of questions:

  • Will I need a blood transfusion? If so, why?
  • What are the risks involved with blood transfusions?
  • What are the risks if I choose to avoid a blood transfusion?
  • What is my physician prepared to do to minimize or eliminate the need for a blood transfusion in my care plan?
  • What can be done before surgery to reduce my risk of bleeding and need for a blood transfusion?
  • If I do need a blood transfusion, how might it affect my recovery?

Although blood transfusions are an effective way to raise hemoglobin levels and reduce anemia-related symptoms, the risks of transfusion sometimes outweigh the benefits and you should discuss these treatment options thoroughly with your doctor.

Severity of Anemia
Severity Hb Range (g/dL) Symptoms Medical Attention
Mild 9.5-13.0 Often no signs or symptoms Commonly remains untreated
Moderate 8.0-9.5 May present with symptoms Requires management to prevent complications from developing
Severe < 8.0 Symptoms usually present May be life threatening and requires prompt management
Elesevier Oncology. Guide to Oncology Drugs and Regimens 2006.8

Deciding on Treatment Options

A complete understanding of why blood transfusions can cause increased risk for some patients is not entirely known, but scientific evidence has led experts and organizations to recommend giving transfusions only when they are necessary. Despite these recommendations, transfusions remain a commonly used therapy. Because they are beneficial, but can at times present increased risks for patients, a controversy has developed in the medical community over when it is best to use transfusions to treat anemia and when other treatments may be safer.

Spence quote“Patients should be aware of the significant controversy that surrounds the use of transfusions and they should ask their doctor how they can avoid transfusion when possible,” cautions Dr. Aryeh Shander, Chief of the Department of Anesthesiology and Critical Care at Englewood Hospital and Medical Center. Dr. Spence stresses this action for surgical patients, adding that “Patients who need surgery should always discuss the possibility of transfusion and any alternatives in advance of their scheduled procedure, even if the surgeon doesn’t bring the topic up.”

Transfusion represents one treatment option for patients with anemia, but transfusions are normally not a patient’s only option for recovery. Your doctor may discuss other types of treatments for anemia, including the use of nutritional supplements or hormone therapy. These are also well-established treatments for anemia, and if they are right for you they may be able to raise your hemoglobin level without subjecting you to the possible risks associated with transfusion.

Nutritional Supplements

If your body is lacking certain vitamins or minerals, like iron, vitamin B12 or folic acid, nutritional supplements may be able to raise your hemoglobin level and reduce your need for a blood transfusion. Your body needs each of these nutrients to make healthy red blood cells, which you can read about in the Anemia and Nutrition articles The Importance of Iron and The Importance of Essential Vitamins. Supplements for these nutrients are taken daily on your own or they can be administered at your doctor’s office. Iron supplements are the most common and given to patients who have an iron deficiency, the most common cause of anemia. Patients may experience side effects with oral iron pills or iron injections, so it is important to consult with your doctor before using them. You can also learn more about iron treatments and their side effects in the articles A Patient’s Guide to Oral Iron Supplements and Are Iron Injections Right for You?

Erythropoiesis-Stimulating Agents

Another treatment for anemia includes erythropoiesis-stimulating agents (ESAs), a man-made hormone which boosts the body’s processes for making red blood cells. These medications are approved for treating anemia in patients with cancer, chronic kidney disease or HIV/AIDS, and some studies have shown the benefits of their use in other types of patients as well.4-6 ESAs are given in conjunction with iron injections and both are administered at your doctor’s office. Treatment with ESAs are not for all patients and some recent studies have shown that ESA use is associated with increased heart-related risks. Read the article to learn more about how ESA Drugs Treat Anemia By Stimulating Red Blood Cell Production and talk to your doctor to see if ESAs are an available treatment option for your anemia.

Blood bagsTreating Transfusions Like Part of the Solution

There is no doubt that the use of transfusions to treat anemia saves lives. This is especially true for trauma patients who have lost an extensive amount of blood in a brief period of time. However, for many patients whose anemia developed gradually, using transfusions to raise hemoglobin levels may present unnecessary risks.

If you are anemic, it is important to speak with your doctor about the best way to raise your hemoglobin level and reduce anemia-related symptoms. This may include several different kinds of treatments, including transfusions, and may be an ongoing process with your doctor and other medical professionals. Managing anemia and establishing a healthy hemoglobin level is an important part of the healing process which can help you get back on track and improve your overall wellbeing.


  1. Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: a systematic review of the literature. Am J Med. 2004 Apr 5;116 Suppl 7A:58S-69S. Link.
  2. Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth. 2008 Jan-Jun;11(1):15-19. Link.
  3. Rose AH, Kotzé A, Doolan D, Norfolk DR, Bellamy MC. Massive transfusion--evaluation of current clinical practice and outcome in two large teaching hospital trusts in Northern England. Vox Sang. 2009 Oct;97(3):247-53. Link.
  4. Trovarelli T, Kahn B, Vernon S. Transfusion-free surgery is a treatment plan for all patients. AORN J. 1998 Nov;68(5):773-88. Link.
  5. Gasché C, Dejaco C, Waldhoer T, Tillinger W, Reinisch W, Fueger GF, Gangl A, Lochs H. Intravenous iron and erythropoietin for anemia associated with Crohn disease. A randomized, controlled trial. Ann Intern Med. 1997 May 15;126(10):782-87. Link.
  6. Murphy EA, Bell AL, Wojtulewski J, Brzeski M, Madhok R, Capell HA. Study of erythropoietin in treatment of anaemia in patients with rheumatoid arthritis. BMJ. 1994 Nov 19;309(6965):1337-78. Link.
  7. Worldwide Prevalence of Anaemia 1993-2005: WHO Global Database on Anaemia. Edited by Bruno de Benoist, Erin McLean, Ines Egli and Mary Cogswell. Link.
  8. Elesevier Oncology. Guide to Oncology Drugs and Regimens 2006. Link.