Transfusion for Doctors: Why, What & Who

Abstract

Training doctors in transfusion medicine needs a new perspective because the existing knowledge based structure has neither attracted enough doctors nor made the system safer. Safety: Intra-hospital transfusion systems, where most transfusions are delivered by overworked, under skilled PGY1s or PGY2s or nurses, are usually inherently unstable and unsafe. The system itself has to be designed to protect the patient in real hospital life situations. That means competency based training of all staff connected with transfusion and fail safe system design with continuous quality review. Knowledge: The range of knowledge required in a blood centre underscores the difficulty of pigeon holing transfusion medicine in a particular College. More fundamentally, the issue is about what practical benefit the knowledge brings to its owner in terms of jobs or recognition. It includes ‘Health assessment of well donors ‘Relevant viruses, bacteria and prions, ‘Immunology at molecular, cellular, process and tissue levels and the associated clinical syndromes and their management ‘Haematology at molecular, cellular, process and tissue levels of inflammation and coagulation and the congenital anaemias ‘Cytotoxic, immunological or inflammatory effects of chemotherapy and transplantation in malignant haematology ‘Resuscitation and immunological or inflammatory conditions in medicine & surgery, with implications for blood products ‘Public health particularly for management of public safety, regulatory systems and health economics Transfusion knowledge is broad and often task specific. Developing appropriate task specific experts requires training and research publications to develop credibility and professional networks.