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Accrediting and regulatory agencies make specific mention of blood transfusion in a number of core functions essential to quality medical care. For example, the need for transfusion is considered one of the key parameters for determining the appropriateness of an operative procedure. An acute hemolytic transfusion reaction due to ABO incompatibility is specifically identified as a reviewable sentinel event for which a comprehensive analysis of cause, corrective action, preventive action and reporting are required. Blood transfusion is acknowledged to be a therapy that involves risks, so that the organization’s performance monitoring and improvement program must address the use of blood and blood components. Furthermore, a cross functional group of medical and support staff is charged with the responsibility to take the leadership role in improving transfusion practice when indicated.

Successful performance of these functions requires that the medical staff agree to some set of practice guidelines for ordering blood transfusion. Ideally, practice guidelines would be grounded in well designed clinical trials that clearly establish efficacy and quantify risk, in at least the most common settings in which this therapy is applied. The current literature does provide guidelines for some of the more commonly encountered clinical situations. However, variability in transfusion practice often reflects expert opinion, tradition, community practice, or personal experience.

Given the known and hypothetical risks of transfusion, as well as the cost, liability and workload involved with this therapy, there are many reasons to move the basis of transfusion practice in a particular institution away from anecdotal experience and tradition, and toward expert advice and clinical evidence. This brochure was revised in order to provide up to date blood usage guidelines from experts and expert panels, as well as the results of significant clinical transfusion trials, published in the English language in peer-reviewed journals since 2002. The authors, all of whom are physician staff for the American Red Cross, have made every attempt to fairly reproduce the advice and lessons contained in these publications. It is their hope that this brochure will be a valuable resource to hospitals who obtain blood and blood components from the American Red Cross as they develop and update their blood usage guidelines for the purpose of improving transfusion safety.

CONTENTS

Introduction
Red Blood Cells

General Information
Utilization Guidelines

Platelets

General Information
Utilization Guidelines

Frozen Plasma

General Information
Utilization Guidelines

Cryoprecipitated-AHF

General Information
Utilization Guidelines

Role of the Hospital Transfusion Committee
Appendix: Side Effects and Hazards of
Blood Transfusion
References

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