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Recent developments - Blood transfusion medicine
BMJ 2002;325:143-147 ( 20 July )
Clinical review
Recent developments
Blood transfusion medicine
Fiona Regan, honorary senior lecturer and consultant haematologist a, Clare Taylor, consultant in haematology and transfusion medicine b.
a Hammersmith Hospitals NHS Trust, London W12 0HS, b Royal Free Hampstead NHS Trust, London NW3 2QG
Correspondence to: F Regan fiona.regan@nbs.nhs.uk
In the past few years there has been increasing concern about blood transfusion safety. Avoidable transfusion errors, mostly in patient identification, remain a serious cause of injury and death. There is also heightened awareness of the risk of transmission of viral and bacterial infections. Of particular concern in Britain is the (theoretical) possibility of transmission of variant Creutzfeldt-Jakob disease.
This review puts these risks in perspective (table) and describes the new measures that have been introduced to improve blood safety. It also describes changes in attitude and practice that will affect users of blood in all disciplines, including general practitioners advising patients of the pros and cons of transfusion. Finally it emphasises the need for careful education and training of all those involved in blood prescribing and blood component administration.
Full Article Online
Includes:
Box 3: Methods of minimising transfusion
Preoperative planning - History and examination including surgical or bleeding history
- Full blood count, "group and save," blood chemistry, coagulation, haematinics
- Consider autologous blood deposit
- Consider erythropoietin to boost haemoglobin concentration
- Treat iron or folate deficiency
- Stop aspirin prophylaxis if possible
Day of admission - Check if taking aspirin, non-steroidal anti-inflammatory drugs, anticoagulants
- Repeat full blood count and "group and save"
- Weigh patient, calculate blood volume, and estimate blood loss that would reduce packed cell volume to 0.22
- Consider acute normovolaemic haemodilution and intraoperative or postoperative cell salvage
- Consider drugs to reduce bleeding (such as aprotinin)
During surgery - Be prepared for longer duration to secure haemostasis
- Consider hypotensive surgery if appropriate
- Avoid hypothermia
 give all fluids through a warmer
- Use of near patient testing
- Consider fibrin glues and sealants
Postoperative care - Accept lower postoperative haemoglobin concentration
- Accept transfusions of just one unit of blood, to exceed transfusion trigger
- Use continuous face mask oxygen if patient has low haemoglobin concentration
- Prescribe iron and folic acid routinely
- Consider tranexamic acid
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Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email
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