It is well known that errors in blood transfusion practices can lead to serious consequences for the recipient in terms of morbidity and mortality. The majority of errors occur due to incorrect sampling of blood from a patient, fetching the wrong unit of blood for a patient and transfusing blood inappropriately.
Clinical transfusion guidelines describe protocols for the collection of blood samples for blood grouping and cross matching, and for the collection, storage and administration of blood and blood products.
The guidelines provide a standardized approach to transfusion so that the potential for errors is minimized and the administration of safe and efficacious blood products in the health care setting is maximized. They also contain protocols for the investigation and treatment of adverse transfusion reactions and provide guidelines for the use of specialised blood products.
• The patient with acute blood loss should receive effective resuscitation (intravenous replacement fluids, oxygen and other medication) immediately and the need for transfusion is estimated thereafter.
• The patient’s haemoglobin (Hb) value, although important, should not be the sole deciding factor in the decision to transfuse blood. This decision should be supported by the need to relieve clinical signs and symptoms and to prevent significant morbidity or mortality.
• Clinicians should be aware of the risk of transfusion transmissible infections in blood products prescribed for patients.
• Transfusion should be prescribed only when the benefits to the patient are likely to outweigh the risks.
• Clinicians should clearly record the reason for ordering a transfusion (clinical diagnosis).
• Trained staff should monitor a patient undergoing transfusion and respond immediately there are signs of an adverse effect.
Blood for transfusion is considered safe when it is:
• Donated by a carefully selected, healthy donor
• Free from infections that could be harmful to the recipient
• Processed by reliable methods of testing, component production, storage and transportation
• Transfused only upon need and for the patient’s health and wellbeing The quality and safety of blood and blood products must be assured throughout the process from the selection of blood donors to the administration of blood into the patient. This is described in the
WHO Blood Safety Initiative:
• Establishment of a well‐organized blood transfusion service with quality system in all areas.
• Collection of blood only from voluntary non‐remunerated donors from low‐risk populations, using rigorous procedures for donor selection.
• Screening of all donated blood for transfusion transmissible infections i.e. HIV, HBV, HCV, syphilis and malaria.
• Good laboratory practice in all aspects of blood grouping, compatibility testing, component preparation and the storage and transportation of blood and blood products.
• Reduction of unnecessary transfusions through the appropriate clinical use of blood and blood products and the use of simple alternatives to transfusion when possible.
Transfusion of blood and products should be undertaken only to treat a condition that would lead to significant morbidly or mortality and that cannot be prevented or managed effectively by other means.