Safe Blood Starts with Me - libdoc.who.int - World Health Organization

ANNEX 4. THE APPROPRIATE CLINICAL USE OF BLOOD AND BLOOD PRODUCTSInformation for CliniciansThe appropriate use ofblood and blood productsBlood transfusion is anessential part of modernhealth care and has alsodemonstrated its efficacyin secondary health carein developing countries.Used appropriately, transfusion cansave life and improve health.However, it always carries potentialrisks for the recipient and should beprescribed only for conditions withsignificant potential for morbidity ormortality that cannot be prevented ormanaged effectively by other means.Transfusion is often unnecessary forthe following reasons.1. The need for transfusion can oftenbe avoided or minimized by theprevention or early diagnosis andtreatment of anaemia andconditions that cause anaemia.The patient’s haemoglobin levelcan often be raised by iron andvitamin supplementation withoutthe need for transfusion. Red celltransfusion is needed only if theeffects of chronic anaemia aresevere enough to require rapidraising of the haemoglobin level.2. Blood is often unnecessarily givento raise a patient’s haemoglobinlevel before surgery or to allowearlier discharge from hospital.Where possible, anaemia shouldbe corrected and depleted ironstores replaced before plannedsurgery.3. Transfusions of whole blood, redcells or plasma are often givenwhen other treatments, such asthe infusion of normal saline orother intravenous replacementfluids would be safer, lessexpensive and equally effective forthe treatment of acute blood loss.4. Patients’ transfusionrequirements can often beminimized by good anaestheticand surgical management,including:• using the best anaesthetic andsurgical techniques to minimizeblood loss during surgery• stopping anticoagulants andanti-platelet drugs beforeplanned surgery, where it issafe to do so• minimizing the blood taken forlaboratory use, particularly inchildren• salvaging and reinfusingsurgical blood losses• using alternative approachessuch as desmopressin,aprotinin or erythropoetin.Safe blood transfusionBefore prescribing blood or bloodproducts for a patient, it is alwaysessential to weigh up the risks oftransfusion against the risks of nottransfusing.The transfusion of red cell productscarries a risk of serious transfusionreactions and the transmission ofinfections, such as HIV, hepatitis B,hepatitis C, syphilis, malaria andChagas disease.Plasma can transmit most of theinfections present in whole blood andcan also cause transfusion reactions;there are very few indications for itstransfusion and the risks very oftenoutweigh any possible benefit to thepatient.Any blood product can becomecontaminated with bacteria and isvery dangerous if it is manufacturedor stored incorrectly.The risks associated with bloodtransfusion depend on:— the incidence and prevalence oftransfusion-transmissibleinfections (TTIs) in the blooddonor population— the effectiveness of procedures forblood donor recruitment,selection, screening, deferral andexclusion: blood donated byregular voluntary nonremunerateddonors carries alower risk of transfusiontransmissibleinfection than blooddonated by family/replacementdonors while paid blood donors125 ▲ WORLD HEALTH DAY ▼ SAFE BLOOD STARTS WITH ME