Blood transfusion

Blood transfusion is widely used in clinical practice.

• in 2014/15 NHS Blood and Transplant issued 1.7 million units of red blood cells, 275,000 units of platelets, 215,000 units of fresh frozen plasma and 165,000 units of cryoprecipitate to hospitals in England and North Wales;
  • there has been an approximate 25% decline in the transfusion of red blood cells in England in the last 15 years
  • the red blood cell transfusion rate declined from 45.5 to 36 units per 1,000 people between 1999 and 2009, and since then has dropped further to around 31.5 units per 1,000 people.

However the benefits of transfusion have been mostly taken for granted and excessive use has placed the patients at unnecessary risk of receiving the wrong blood and of complications of transfusion.

• the Serious Hazards of Transfusion (SHOT) scheme estimated that in 2014 the risk of transfusion-related death was 5.6 per million blood components issued, and the risk of transfusion-related major morbidity was 63.5 per million blood components issued
• most common cause of death associated with transfusion was transfusion associated circulatory overload.

Before transfusion it is important assess whether the patient require blood transfusion.

• transfusion should only be carried out if benefits outweigh the risks and there are no appropriate alternatives
• if transfusion decision has been made, ensure that it is
  • right blood
  • right patient
  • right time
  • right place (1)

Transfusion of blood and blood products may be indicated in a variety of situations. Specific situation will dictate the most appropriate blood product. e.g. -

• red blood cells
  • treat haemorrhage and to improve oxygen delivery to tissues
• plasma
  • patients with active bleeding and an International Normalized Ratio (INR) greater than 1.6,
  • before an invasive procedure or surgery if a patient has been anticoagulated
• platelets
  • in patients with thrombocytopenia or platelet function defects.
• cryoprecipitate
  • in cases of hypofibrinogenemia (2)

Ideally, the patient's blood group and rhesus status should be known, and blood should be cross-matched with the proposed donor blood. Otherwise, universal donor blood - group O negative - is used

Reference:

• (1) Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. Handbook of transfusion medicine (2013).
• (2) Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011;83(6):719-24