Transfusion medicine is a challenging and complex medical practice that occurs in virtually every hospital, except perhaps rehabilitation and mental health facilities, on a frequent, often daily, basis. The knowledge base required to effectively meet the standard of care for transfusion practice is increasing at a rapid pace. It is not unusual for patients with successful ABO changes due to bone marrow or stem cell transplantation to be treated in their local community hospital or even to receive such transplantations much closer to home than previously. Routine transfusions for patients with anemia, hemoglobinopathies, elective surgeries, and trauma, as well as the special needs of neonates and geriatric patients, are provided in hospital transfusion services of all sizes. In some hospitals, there are board-certified physician specialists in transfusion medicine who provide hands-on consultative services to their colleagues, whereas in other facilities, the technical specialists (including blood banking and specialist in blood banking certified personnel) shoulder much of the burden of providing these services.
This special section on transfusion medicine was written by internationally recognized transfusion medicine and blood management experts who practice in the United States. The topics that have been selected are intended to assist the pathologist or other physician specialist with responsibility for transfusion services whose primary focus is not transfusion medicine to better understand and have current references on the selected topics. The section includes best practices in handling and administering blood for transfusion, blood management, risks (infectious and noninfectious) of blood components, pathogen inactivation, and oxygen therapeutics (so-called blood substitutes). Each is discussed briefly in the following paragraphs.
However, one should note that some topics have not been selected for inclusion in this special section, most often because there are excellent and fairly recently published articles and/or textbooks to which the reader will be separately referred. Examples of topics that are not specifically separately written for this section include transfusion reactions,1 the transfusion committee,2 neonatal and pediatric transfusions,3 therapeutic apheresis,4 informed consent,5 and ethical issues.6
The first article in this series is a case-based description of routine transfusion practice, focusing on the commonly encountered challenges seen in most transfusion services. Using the cases and the discussions that follow, it should be relatively easy to audit actual practices within any transfusion service and discover where improvements are possible. This article is complemented by the following article in which important concepts of blood management are described. Blood management includes such concepts as bloodless surgery, perioperative blood recovery and reinfusion (salvage), and chemical management of anemia. Many hospitals are engaged in evaluating the evidence-based practice of transfusion, which may include applying the principles articulated in this article and avoiding transfusion when medically appropriate.
When transfusion is required, the patient should be advised of the current risks of receiving blood components, based on the type of component and its attendant risks. Both the noninfectious and infectious risks should be correctly and completely discussed with any patient before administration of a blood transfusion. Two articles in this series list the state-of-the-art risk numbers and factors that should be familiar to practitioners and form the basis of the informed consent discussion with patients.
The last 2 articles in this section are descriptions of the status of ongoing research to attempt to provide even safer blood components: by inactivating all known and many unknown agents of disease or by providing a novel transfusion product such as an oxygen-carrying material in place of red blood cells. Although only small progress has been made in transferring these research findings into practice (solvent-detergent plasma is an example of a pathogen-inactivated blood component that is currently available for transfusion), the status of current efforts may be helpful to those whose primary focus is not in this literature.
Although this special section is not a complete text on the subject of transfusion medicine (there are many excellent ones7–13), it is our hope that this handy supplement on the state-of-the-practice will facilitate safe patient transfusions, when transfusions are indicated, or minimize or avoid transfusions as appropriate in institutions of all sizes.
The author has no relevant financial interest in the products or companies described in this article.
Reprints: Kathleen Sazama, MD, JD, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 800, Houston, TX 77030 (email@example.com)