Abstract
Blood transfusion is a common procedure in the hospital setting, and the safety of the blood supply has been vastly improved over the past few decades largely due to improvements in screening for viral transmissible diseases, especially human immunodeficiency virus (HIV) and viral hepatitis. However, more recent efforts to improve blood safety have focused on non-transmissible disease risks such as transfusion-related acute lung injury (TRALI), non-viral transmissible diseases such as bacterial contamination of blood products (especially platelet components which are stored at room temperature) and Chagas disease (a parasitic disease caused by Trypanosoma cruzi), and prion transmissible agents (e.g., variant Creutzfeldt-Jakob disease, also known as the agent of mad cow disease) as well as more recently-recognized transmissible viral disease risks such as West Nile virus. Appropriate blood utilization has also come under more intense scrutiny in recent times due to healthcare costs and the recognition that many blood transfusions are given under circumstances in which the benefit to the patients is unclear and may be potentially harmful due to the above risks as well as the emerging concept that blood transfusions may cause long-term damage to the immune system resulting in worse patient morbidity and mortality outcomes. Toward that end, accreditation agencies such as the Joint Commission and the American Association of Blood Banks (AABB) are advocating for healthcare organizations to implement appropriate patient blood management strategies. This review will examine these issues along with newer blood safety technological innovations and further highlight contributing studies from our institutions.
Highlights
IntroductionIt was reported that there were nearly 15 million whole blood and red blood cell units transfused in the United States alone in 2008, representing a nearly 6% increase in transfusions from the prior surveyed year of 20061
Blood transfusion is one of the most common procedures performed in hospitals
While it is certainly known that anemia can have adverse effects on patients, in cardiovascular and neurocritical care patients[2,3,4], what is becoming more evident is that correction of anemia via blood transfusion is not beneficial to many patients, and may be more harmful, unless the patient is acutely symptomatic from the anemia
Summary
It was reported that there were nearly 15 million whole blood and red blood cell units transfused in the United States alone in 2008, representing a nearly 6% increase in transfusions from the prior surveyed year of 20061 This is because anemia is a common comorbidity that can be found in a variety of patients, including patients with cancer, patients undergoing surgical procedures or hemodialysis, patients with autoimmune or bone marrow disorders (such as myelodysplastic syndrome), patients with congenital anemia (such as sickle cell anemia and thalassemia), trauma patients, obstetrical patients, and patients with nutritional deficiencies, such as iron deficiency. Additional studies have been published demonstrating similar outcomes in other patient populations such as elderly patients undergoing orthopedic (e.g., hip replacement) surgery, pediatric patients, and patients with gastrointestinal bleeding[6,7,8] Despite these data supportive of restrictive transfusion strategies along. This review will further discuss issues surrounding blood utilization, including the safety and quality of the blood supply and patient blood management
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