Blood transfusion medicine

doi:10.1136/bmj.325.7356.143

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Fiona Regan, honorary senior lecturer and consultant haematologist (fiona.regan@nbs.nhs.uk)a,
Clare Taylor, consultant in haematology and transfusion medicineb

^a Hammersmith Hospitals NHS Trust, London W12 0HS
^b Royal Free Hampstead NHS Trust, London NW3 2QG

Correspondence to: F Regan

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.

Summary points

Human error is a cause of transfusion related morbidity and mortality: these errors are entirely avoidable

The adoption of a lower “transfusion trigger” is gaining acceptance

Whether or not variant Creutzfeldt-Jakob disease is transmissible by transfusion, it may have a considerable impact on availability of blood for transfusion

Concerted efforts must now be made to reduce inappropriate blood use and to use alternatives and blood sparing agents

Pilot studies of barcode patient identification systems are assessing their feasibility in various clinical settings

Phase III clinical trials of blood substitutes (haemoglobin solutions and perfluorocarbons) are in progress

View this table:

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Risks of red blood cell transfusion (adapted from British Committee for Standards in Haematology (2001)¹)

Methods

Our review is based on information from the annual reports of Serious Hazards of Transfusion (www.shot.demon.co.uk/), the guidelines of the British Committee for Standards in Haematology (www.bcshguidelines.com/), and the chief medical officer's second “Better Blood Transfusion” meeting (www.doh.gov.uk/bbt2). We also cite relevant recent publications by leading clinicians and scientists.