Reducing perioperative blood use
BMJ 2007; 335 doi: https://doi.org/10.1136/sbmj.0712454 (Published 01 December 2007) Cite this as: BMJ 2007;335:0712454
- Robert Choa, senior house officer1,
- Siobhan Leith, consultant anaesthetist2
- 1Stoke Mandeville Hospital, Buckinghamshire HP21 8AL
- 2Arrowe Park Hospital Wirral
Producing blood components costs the UK National Health Service 500m pound (700m euro; $1bn) a year,1 and each unit costs about 120 pound. In all, 2.5 million units are donated a year.2 This article considers transfusion of red blood cells, rather than other blood products. Although there are risks associated with transfusing blood (box 1), it can save lives and improve patients' health. It is most often used in the following circumstances:
Patients with acute heavy blood loss after an injury or operation
Patients with symptomatic anaemia-for example, a low haemoglobin concentration regardless of cause combined with dyspnoea, fatigue, or angina, especially in patients with pre-existing cardiac disease
Patients who have specific haematological diseases (such as sickle cell disease) or bone marrow suppression.
Risks in blood transfusion
UK hospitals are asked to report adverse events arising from transfusions to the Serious Hazards of Transfusion office. The proportion of reports regarding each type of hazard is shown in brackets, for 1996-2004, if available.3
Acute haemolytic reaction-Intravascular haemolysis caused by complement fixing IgM antibodies, which can be life threatening (10.2%)
Transfusion transmissible infections-Risks are very low: for example, 1.66 per million units for hepatitis B, 0.80 for hepatitis C, and 0.14 for HIV, in donations entering the UK blood supply, 1996-20034 (1.8%)
Allergic reaction-Occurs as a result of the body's reaction to plasma proteins in donated blood
Febrile reaction-The patient spikes a fever during the transfusion or within 24 hours because of cytokines released from white blood cells. It is more common in patients who have had previous transfusions and in multigravida women. All donated blood is now leucodepleted, reducing the likelihood of this complication
Circulatory overload
Iron …
Log in
Log in using your username and password
Log in through your institution
Subscribe from £173 *
Subscribe and get access to all BMJ articles, and much more.
* For online subscription
Access this article for 1 day for:
£38 / $45 / €42 (excludes VAT)
You can download a PDF version for your personal record.