Red blood cell transfusions for anemia

Abstract

N THE LAST FOUR decades many advances have increased the safety and effectiveness of blood transfusion, t'2 including the identification of numerous clinically significant red cell antigens and antibodies. The risk of contracting transfusiontransmitted diseases has been vastly reduced by donor testing and thorough history screening. Technological developments have all but eliminated the use of whole blood, with most units being separated into components soon after blood donation. Concentrated products, such as packed red cells, maximize therapeutic benefit while limiting the risk of circulatory overload. This advance has had a significant impact on the treatment of oncology patients. Highly toxic treatment regimens, combined with aggressive transfusion support, are decreasing the morbidity and mortality of malignant disease and treatment. In spite of refinements in transfusion medicine practice which have made red blood cell (RBC) transfusion seem simple and safe, there are still potentially serious consequences. Approximately l in 100 transfusions is accompanied by fever, chills, or urticaria. Although these reactions are usually mild, 1 in 6,000 RBC transfusions results in an acute or delayed hemolytic reaction. Thirty fatal transfusion reactions are reported each year, almost all related to errors involving ABO incompatibility. The chance of contracting the human immunodeficiency virus (HIV) through transfusion is estimated to be 1 in 150,000, while 1 in 500 multiple-transfused recipients develop abnormal liver function studies, indicating some type of viral hepatitis) At the 1988 National Institutes of Health (NIH) Consensus Conference on Perioperative Red Cell Transfusion, experts in the field presented data which indicate that patients with hemoglobin levels below 10 g/dL do not have an increased incidence of surgical complications. There is no increase in anesthesia-induced hypotension or cardiac arrythmias, and wound healing is not delayed if perfusion remains adequate. 4 The recommendation resulting from the conference--to abolish hemoglobin trigger values and determine transfusion needs by the patient's clinical statushas significantly changed transfusion medicine practice.