Transfusion Medicine

Abstract

Transfusion medicine has advanced to a laboratory-based clinical discipline because of key discoveries and technical advances. These include the discovery of blood group antigens and the understanding of the host immune response to these antigens, development of methods of anticoagulation and storage of blood, and creation of plastic bags that allow sterile fractionation of whole blood into components. The potential of blood to act as an agent of disease transmission has heavily shaped both the donation process and transfusion practice. This chapter offers information to help the physician decide whether to transfuse. It includes sections on blood donation (autologous and directed), on postdonation screening procedures for the presence of viral agents (e.g., hepatitis, retrovirus, and emerging infectious pathogens), on pretransfusion testing (i.e., antigen phenotyping and testing for the presence of antibodies), and on blood components. Sections give specific information on transfusion of red cells, platelets, fresh frozen plasma, and recombinant clotting factors. Indications and complications of apheresis are described. Complications of transfusions are discussed, as are future prospects for transfusion therapy. Tables detail the advantages and disadvantages of autologous donation, estimated risks of blood transfusion, characteristics of blood products and indications for their use, plasma and recombinant clotting factors, indications for recombinant factor VIIa therapy, indications for the use of irradiated blood products, indications for the use of cytomegalovirus-negative blood products, and recommendations for therapeutic apheresis. This chapter contains 154 references.