Literature Review
Introduction
There has been much debate within the peri-operative environment at a regional New South Wales hospital regarding the management and transfusion of red blood cells. This is why the topic has been selected for further study. The purpose of this paper is to review the literature surrounding the safety of red blood cell (RBC) transfusions, which comes under standard seven of the National Safety and Quality in Health Service Standards (ACSQHC, 2012). It will touch on the complications of RBC transfusion, when to transfuse, the management of blood loss and the impact of RBC transfusion on critically ill patients. The paper will aim to answer the following questions: ‘To transfuse or not to transfuse, do the risks of transfusion outweigh the benefits?’ It will also examine and critically analyse strategies that have been put in place to reduce errors in the administration of blood and also strategies aimed at reducing blood loss and therefore decrease the chance of a patient needing to be transfused. Similarities, differences and omissions of each research article will be examined. The relevance of these issues to the peri-operative environment will be evaluated, and conclusions and recommendations will be made.
In the peri-operative environment, red blood cells transfusions are used to treat haemorrhage and to improve oxygen delivery to tissue. Approximately 85 million red blood cell units are transfused annually worldwide (American Association of Blood Banks, 2012). They are seen to have remarkable health benefits for patients and have undoubtedly saved the lives of thousands of people. Unfortunately, there is considerable risk involved. The leading cause of RBC related mortality is transfusion-related acute lung injury (TRALI), ABO and non-ABO haemolytic transfusion reactions (HTR) and transfusion related sepsis (TAS). Inappropriate or incorrect transfusion of RBC is the most frequent cause for HTR. Errors can arise from donor choice, laboratory and
There has been much debate within the peri-operative environment at a regional New South Wales hospital regarding the management and transfusion of red blood cells. This is why the topic has been selected for further study. The purpose of this paper is to review the literature surrounding the safety of red blood cell (RBC) transfusions, which comes under standard seven of the National Safety and Quality in Health Service Standards (ACSQHC, 2012). It will touch on the complications of RBC transfusion, when to transfuse, the management of blood loss and the impact of RBC transfusion on critically ill patients. The paper will aim to answer the following questions: ‘To transfuse or not to transfuse, do the risks of transfusion outweigh the benefits?’ It will also examine and critically analyse strategies that have been put in place to reduce errors in the administration of blood and also strategies aimed at reducing blood loss and therefore decrease the chance of a patient needing to be transfused. Similarities, differences and omissions of each research article will be examined. The relevance of these issues to the peri-operative environment will be evaluated, and conclusions and recommendations will be made.
In the peri-operative environment, red blood cells transfusions are used to treat haemorrhage and to improve oxygen delivery to tissue. Approximately 85 million red blood cell units are transfused annually worldwide (American Association of Blood Banks, 2012). They are seen to have remarkable health benefits for patients and have undoubtedly saved the lives of thousands of people. Unfortunately, there is considerable risk involved. The leading cause of RBC related mortality is transfusion-related acute lung injury (TRALI), ABO and non-ABO haemolytic transfusion reactions (HTR) and transfusion related sepsis (TAS). Inappropriate or incorrect transfusion of RBC is the most frequent cause for HTR. Errors can arise from donor choice, laboratory and
References: Australian Commision on Safety and Quality in Healthcare, 2012, National Safety and Quality Health Standards, Sydney, Australia. Carson, JL., Grossman, BJ. Kleinman, S. et al, 2012, ‘Red blood cell transfusion: a clinical practice guideline from the AABB’, American College of Physicians, 157; 1; 49-58. Davies, A., Staves, J., Kay, J., Casbard, A. and Murphy, MF., 2006, ‘End-to-end electronic control of the hospital transfusion process to increase the safety of blood transfusion: strengths and weaknesses’, Transfusion, 46: 1: 352-364. Frellick, M., 2012, ‘Better blood management could be a boon for hospitals’, Hospital and Health Networks, 86; 9; 46-48. Gombotz, H., Rehak, PH., Shander, A. and Hoffman, A., 2007, ‘Blood use in elective surgery: the Austrian benchmark study’, Transfusion, 47; 7; 1468-1480. Herbert, PC., Wells, G. and Blajchman, MA., 1999, ‘A muticenter, randomized, controlled clinical trial of transfusion requirements in critical care’, New England Journal of Medicine, 340; 6; 409-417. Murphy, MF., 2007, ‘Application of barcode technology at the bedside’, Transfusion, 47; 6; 120S-124S. National Health & Medical Research Council/Australian Society of Blood Transfusion, 2001, Clinical practice guidelines: appropriate use of red blood cells, Sydney, Australia. Shander, A., Javidroozi, M., Perelman, S., Puzio, T. and Lobel, G., 2012, ‘From bloodless surgery to patient blood management’, Mount Sinai Journal of Medicine, 79; 1; 56-75. Sharma, S., Sharma, P. and Tyler, L., 2011, ‘Transfusion of blood and blood products: indications and complications’, American Family Physician, 83; 6; 719-724. Thomas, D. and Holmes, T., 2011, Complications of blood products and fluid infusions, Cambridge University Press, New York.