The importance of blood transfusion in clinical practice cannot be denied. The benefits of blood and blood products are unique and manifold. However the benefits are not without its accompanying hazards. It is of utmost importance that blood for transfusion is safe with its quality unquestioned. Any compromise on this can lead to serious consequences for the patient. The common errors to watch out for in blood transfusion are transcription errors, labelling errors, incorrect sampling of blood from donor, administering wrong unit of blood to patient and not following proper protocol during transfusion.
For transfusion to be done in a safe manner, the following factors need to be addressed:
What is anaemia?
It is a condition in which there is a shortfall of RBC, as a result the oxygen that the RBC delivers to the peripheral tissue is also reduced. Anaemia is measured by haemoglobin level, the haematocrit and the RBC concentration in cells per litre. Generally haemoglobin level is what physicians prefer to find out the severity of anaemia. For practical purposes, the haematocrit concentration is used. The World Health Organization classifies the severity of anaemia according to the following values:
Non-anaemic (›11g/dl)
Mild anaemia (9.5-10.9 g/dl)
Moderate anaemia (8-9.4/dl)
Severe (6.5 – 7.9 g/dl)
Indications for Transfusion in Anaemia
Blood transfusion is not mandatory for anaemia. To tackle anaemia, the following options can be tried:
As already pointed out, the transfusion of blood is not carried out based on the haemoglobin value alone. The transfusion should have an effect towards the betterment of the patient’s lifestyle. The WHO advises transfusion only for patients with haemoglobin ‹ 6.5 g/dl. If the reason for anaemia is only iron deficiency, then transfusion is not done as various other simpler treatment options are available. In elderly patients with severe anaemia, transfusion is recommended especially when patient presents with conditions like angina and congestive heart failure.
Haemolytic anaemia caused by haemolysis also requires transfusion.
In anaemic patients, the RBCs do not supply adequate amount of oxygen to the tissues. Therefore the heart pumps harder to meet the oxygen demand. As a result, the heart is the organ which has been put to risk in anaemia.
Whole blood transfusion is rarely carried out. What is usually in practice is the separation and usage of red blood cell units alone so that the other blood components (platelets and plasma) can be used for other purposes. RBC transfusion is also not to be considered when the cause of anaemia is iron deficiency or vitamin B12 or folate deficiency. However iron deficient patients when presented with active bleeding are candidates for RBC transfusion. This is because the main concern now is to stabilize the patient. Once the patient has stabilized the treatment for the bleeding can commence.
The AABB (American Association of Blood Banks) gives guidelines for scenarios when RBC transfusion should be considered:
Article by Dr. Shantha Ravisankar,
Chief of Lab Services,
Kauvery Hospital,
Chennai
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