The Transfusion Decision: Prescribing Doctor’s Responsibility
It is the responsibility of the prescribing doctor to ensure that blood component therapy is given only when clearly indicated and that the patient is appropriately monitored during the
transfusion procedure.
In considering the use of allogeneic blood transfusion, these questions need to be addressed:
- What is the haematological effect?
- What is the timeframe of decision making e.g. urgent/elective?
- Is a blood component indicated and what is the most appropriate blood component?
- Are there alternatives to allogeneic transfusion?
- What are the potential hazards of the blood component therapy?
- Can the risk of adverse effects be avoided or minimised?
- How should the component be administered and its efficacy monitored?
- What is the availability and cost of the blood component therapy?
- Is the patient/relative(s) fully informed of and consenting to the medical decisions?
Correctly used, blood components and plasma derived blood products can save lives and provide clinical benefit to many patients. Clinical practice guidelines on the use of blood components have been prepared by the National Health and Medical Research Council (NHMRC) and the Australasian Society of Blood Transfusion (ASBT). These guidelines state that it is increasingly clear that such therapy has limitations and that the decision to transfuse must be made appropriately.
ARCBS recommends that transfusions be administered according to the institutional
guidelines developed by clinical, scientific and other relevant persons. These may be based on guidelines from:
When a decision is made that blood component therapy is indicated, a safe and effective transfusion requires attention to the following details:
- The indication for blood components is clearly defined and documented
- Identification and appropriate management of high-risk patients
- Accurate patient identification for compatibility
- Provision of adequate quantity and quality of components
- Communication of benefits and risks to the patient/relatives
- Minimising the risk of ill effects associated with the transfusion
- Awareness of possible transfusion-related complications
- Early diagnosis and prompt action in relation to adverse events of transfusion
- Input into quality assurance programs
Organisational Responsibility
In all situations where blood component therapy is given, a quality management system is needed.
Successful and safe transfusion practice depends on administering a quality blood component of the right type, in the right amount, in the right way, at the right time to the right patient.
Quality also includes adequate documentation of both the transfusion process, including the decision to transfuse, and outcomes. There is an organisational responsibility to ensure that usage of blood is monitored, reviewed and appropriate actions are taken to ensure that blood is used safely and appropriately.
This can be achieved by the establishment of a clinical/management group to monitor the use of blood components, such as a Hospital Transfusion Committee.