Appropriate and inappropriate transfusion of blood and blood safety

Appropriate and inappropriate transfusion of blood and blood safety

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Blood transfusion can be a life-saving intervention. However, like all treatments, it may result in acute or delayed complications and carries the risk of transfusion-transmissible infections, including HIV, hepatitis viruses, syphilis, malaria and Chagas disease.

The safety and effectiveness of transfusion depend on two key factors:

• A supply of blood and blood products that are safe, accessible at reasonable cost and adequate to meet national needs

• The appropriate clinical use of blood and blood products.

Transfusion is often unnecessary for the following reasons.

1. The need for transfusion can often be avoided or minimized by the prevention or early diagnosis and treatment of anaemia and conditions that cause anaemia.

2. Blood is often unnecessarily given to raise a patient’s haemoglobin level before surgery or to allow earlier discharge from hospital. These are rarely valid reasons for transfusion.

3. Transfusions of whole blood, red cells or plasma are often given when other treatments, such as the infusion of normal saline or other intravenous replacement fluids would be safer, less expensive and equally effective for the treatment of acute blood loss.

4. Patients’ transfusion requirements can often be minimized by good anaesthetic and surgical management.

5. If blood is given when it is not needed, the patient receives no benefit and is exposed to unnecessary risk.

6. Blood is an expensive, scarce resource. Unnecessary transfusions may cause a shortage of blood products for patients in real need.

The risks of transfusion

In some clinical situations, transfusion may be the only way to save life or rapidly improve a serious condition. However, before prescribing blood or blood products for a patient, it is always essential to weigh up the risks of transfusion against the risks of not transfusing.

Red cell transfusion

1. The transfusion of red cell products carries a risk of serious haemolytic transfusion reactions.

2. Blood products can transmit infectious agents, including HIV, hepatitis B, hepatitis C, syphilis, malaria and Chaga’s disease to the recipient.

3. Any blood product can become contaminated with bacteria and very dangerous if it is manufactured or stored incorrectly.

Plasma transfusion

1. Plasma can transmit most of the infections present in whole blood.

2. Plasma can also cause transfusion reactions.

3. There are few clear clinical indications for plasma transfusion. The risks very often outweigh any possible benefit to the patient.

Blood safety

The quality and safety of all blood and blood products must be assured throughout the process from the selection of blood donors through to their administration to the patient. This requires:

1. The establishment of a well-organized blood transfusion service with quality systems in all areas.

2. The collection of blood only from voluntary non-remunerated donors from low-risk populations and rigorous procedures for donor selection.

3. The screening of all donated blood for transfusion-transmissible infections: HIV, hepatitis viruses, syphilis and, where appropriate, other infectious agents, such as Chaga’s disease and malaria.

4. Good laboratory practice in all aspects of blood grouping, compatibility testing, component preparation and the storage and transportation of blood and blood products.

5. A reduction in unnecessary transfusions through the appropriate clinical use of blood and blood products, and the use of simple alternatives to transfusion, wherever possible. Whatever the local system for the collection, screening and processing of blood, clinicians must be familiar with it and understand any limitations that it may impose on the safety or availability of blood.


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