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THE APPROPRIATE CLINICAL USE

OF BLOOD AND BLOOD PRODUCTS

Information Sheet for Clinicians

anaemia should be present in whole blood and can also cause corrected and depleted iron stores replaced transfusion reactions. it is always essential to weigh up the risks need for transfusion. such as HIV. ◆ Salvaging and reinfusing surgical blood Transfusion is often unnecessary for the following losses reasons. Plasma can transmit most of the infections Where possible. transfusion can save life and ◆ Stopping anticoagulants and anti-platelet improve health. The patient’s Safe blood transfusion haemoglobin level can often be raised by iron Before prescribing blood or blood products for a and vitamin supplementation without the patient. fluids would be safer. Red cell transfusion is of transfusion against the risks of not transfusing. However. plasma are often given when other Any blood product can become contaminated treatments. hepatitis 2 Blood is often unnecessarily given to raise a B. transmission of infections. including: Blood transfusion is an essential part of modern health care and has also demonstrated its efficacy ◆ Using the best anaesthetic and surgical in secondary health care in developing countries. techniques to minimize blood loss during surgery Used appropriately. such as the infusion of normal with bacteria and is very dangerous if it is saline or other intravenous replacement manufactured or stored incorrectly. to allow earlier discharge from hospital. aprotinin or 1 The need for transfusion can often be erythropoetin. needed only if the effects of chronic anaemia The transfusion of red cell products carries a risk are severe enough to require rapid raising of of serious transfusion reactions and the the haemoglobin level. depend on: World Health Organization . ◆ Using alternative approaches such as desmopressin. hepatitis C. less expensive and equally effective for the treatment of acute The risks associated with blood transfusion blood loss.Safe blood starts with me The appropriate use of blood 4 Patients’ transfusion requirements can often and blood products be minimized by good anaesthetic and surgical management. malaria and Chagas patient’s haemoglobin level before surgery or disease. syphilis. where it potential risks for the recipient and should be is safe to do so prescribed only for conditions with significant ◆ Minimizing the blood taken for potential for morbidity or mortality that cannot be laboratory use. particularly in children prevented or managed effectively by other means. it always carries drugs before planned surgery. indications for its transfusion and the risks very 3 Transfusions of whole blood. There are very few before planned surgery. avoided or minimized by the prevention or early diagnosis and treatment of anaemia and conditions that cause anaemia. red cells or often outweigh any possible benefit to the patient.

knowledge of the beyond the immediate control of prescribers of occurrence. The extent to which blood is used appropriately Every prescriber of blood should be familiar with depends on a range of factors. selection. for their patients. during ◆ The effectiveness of procedures for blood and after transfusion. World Health Organization . distribution and spread of blood. Other than in the most exceptional life-threatening Remember that. and prevalence of TTIs However. Many of these factors are availability. tested for compatibility between the donor’s red transmissible infections (TTIs) in the blood cells and antibodies in the patient’s plasma. screening and effectiveness of programmes to reduce nutritional processing of blood and understand any anaemia and the availability of intravenous limitations that it may impose on its safety or replacement fluids. However. The decision to transfuse blood or storage and transportation of blood products blood products should always be based on a ◆ The reliability of the system for ensuring that careful assessment of clinical and laboratory patients receive blood that is compatible with indications that transfusion is necessary to save their blood group. Blood saves lives ◆ The incidence and prevalence of transfusion. such as the the local system for the collection. donor population All patients should be monitored before. blood can situations. donor recruitment. deferral and exclusion: blood donated by regular voluntary non-remunerated donors Prescribing blood and blood carries a lower risk of transfusion. products transmissible infection than blood donated by Prescribing decisions should be based on family/replacement donors while paid blood national guidelines on the clinical use of blood. red cell antibodies and life or prevent significant morbidity. responsibility for the decision to ◆ The quality of screening of all donated blood transfuse must ultimately rest with individual for TTIs clinicians. donors generally have the highest incidence taking individual patient needs into account. In particular. ◆ The quality of blood grouping. has been screened for TTIs and has been patients who require it. compatibility The key principle of clinical transfusion practice testing and component preparation is that transfusion is only one part of the patient’s ◆ The efficiency of the blood cold chain for the management. It should also other special requirements be based on knowledge of the resources available ◆ The clinical use of blood and blood products for managing patients and the safety of the blood only when no alternatives to transfusion are and blood products available. blood should not be transfused unless be life-saving. when used correctly. Inappropriate use can endanger it has been obtained from appropriately selected life and may cause a shortage of blood for other donors. screening. it is the responsibility of transfusion-transmissible infections is essential to individual clinicians to ensure that their own informed judgements about the risks and benefits clinical decisions on transfusion are appropriate of transfusion. available.

who. 10 If this blood was for myself or my child. WHO/EHT/06. if in doubt. such as intravenous replacement fluids or oxygen? 4 What are the specific clinical or laboratory indications for transfusion for this patient? 5 What are the risks of transmitting HIV.02. would I accept the transfusion in these circumstances? Blood Transfusion Safety Department of Essential Health Technologies World Health Organization 1211 Geneva 27.int/bloodsafety © World Health Organization. Reprinted August 2006. ask yourself the following question. hepatitis. Switzerland Fax: +41 22 791 4836 E-mail: bloodsafety@who. syphilis or other infectious agents through the blood products that are available for this patient? 6 Do the benefits of transfusion outweigh the risks for this particular patient? 7 What other options are there if no blood is available in time? 8 Will a trained person monitor this patient and respond immediately if any acute transfusion reactions occur? 9 Have I recorded my decision and reasons for transfusion on the patient’s chart and the blood request form? Finally. .int http://www.Safe blood starts with me Prescribing blood: a checklist for clinicians Always ask yourself the following questions before prescribing blood or blood products for a patient 1 What improvement in the patient’s clinical condition am I aiming to achieve? 2 Can I minimize blood loss to reduce this patient’s need for transfusion? 3 Are there any other treatments I should give before making the decision to transfuse. 2000.