General principles of home blood transfusion
- Joy L Fridey, MD
Joy L Fridey, MD
- Regional Medical Director
- American Red Cross Blood Services, Southern California
Blood transfusions traditionally have been administered either in hospitals or outpatient clinics. In an effort to increase the accessibility and convenience of care to chronically ill patients and decrease associated costs, many therapies, including transfusions, are now occasionally given in patients' homes or physicians' offices. The indications for home blood transfusion are similar to those in other healthcare settings. (See "Red blood cell transfusion in adults: Storage, specialized modifications, and infusion parameters".)
There is one major factor that distinguishes the administration of blood in a home setting from transfusion in a hospital: the decreased availability of emergency medical care in the event of a serious complication. This inherent difference compounds the already present and usual risks of transfusion; thus, increased convenience and decreased costs must be subsumed to patient safety.
The key aspects of home transfusion, with the focus on recipient safety, will be reviewed here. Several key references that should be consulted prior to setting up a home transfusion program will be mentioned. Standardized procedures to maximize the safety of home blood transfusion are presented separately. (See "The path to safer home transfusion: Standardized procedures".)
WHOM TO CONSULT AND WHY
Activities related to the collection, processing, issuing, and transfusion of blood and blood components are regulated by government agencies, such as the US Food and Drug Administration (FDA), or individual states. Standards applicable to these processes have been promulgated by organizations such as the AABB (formerly known as the American Association of Blood Banks), College of American Pathologists (CAP), and The Joint Commission. Physicians wishing to order home transfusions should be familiar with applicable standards and regulations. Presumably, a blood center or hospital transfusion service would not issue blood to a healthcare provider or agency that does not have transfusion procedures that meet regulations and industry standards.
The foundation of the transfusion safety and regulatory infrastructure consists of detailed standard operating procedures (SOPs) for every aspect of the transfusion process, from ordering blood, to collecting the pre-transfusion compatibility testing specimen, storing and transporting components, infusing, and proper handling of biohazardous materials, such as blood bags and tubing. Documentation, retention of records, staff training and periodic competency assessment are also required.
- Standards for Blood Banks and Transfusion Services, 28th ed, AABB, Bethesda, MD 2012.
- Anderson K, Benson K, Glassman A, et al. Guidelines for Home Transfusion, American Association of Blood Banks, Bethesda, MD 1997.
- Food and Drug Administration. Code of Federal Regulations (21), Parts 600-799 and 200-299. US Government Printing Office, Washington, DC 2009. www.ecfr.gov (Accessed on May 14, 2013).
- Benson K. Home is where the heart is: do blood transfusions belong there too? Transfus Med Rev 2006; 20:218.
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- Out-of-hospital Transfusion Therapy, Fridey JL, Kasprisin CA, Issitt LA (Eds), American Association of Blood Banks, Bethesda, MD 1994.
- Benson K. Blood Transfusions in the Home Sweet Home: How to Avoid a Sour Outcome. Cancer Control 1997; 4:364.
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- Menis M, Izurieta HS, Anderson SA, et al. Outpatient transfusions and occurrence of serious noninfectious transfusion-related complications among US elderly, 2007-2008: utility of large administrative databases in blood safety research. Transfusion 2012; 52:1968.
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- Niscola P, Tendas A, Giovannini M, et al. Transfusions at home in patients with myelodysplastic syndromes. Leuk Res 2012; 36:684.
- Blood Banking and Transfusion Medicine, 2nd ed, Hillyer CD, Silberstein LE, Ness PM, Anderson KC (Eds), Churchill Livingstone, Philadelphia 2007.
- Technical Manual, 17th ed, Roback JD, Combs MR, Grossman BJ, Hillyer CD (Eds), AABB, Bethesda, MD 2011.
- Barrett BB, Andersen JW, Anderson KC. Strategies for the avoidance of bacterial contamination of blood components. Transfusion 1993; 33:228.
- Fang CT, Chambers LA, Kennedy J, et al. Detection of bacterial contamination in apheresis platelet products: American Red Cross experience, 2004. Transfusion 2005; 45:1845.
- Pearce S, Rowe GP, Field SP. Screening of platelets for bacterial contamination at the Welsh Blood Service. Transfus Med 2011; 21:25.
- Dumont LJ, Kleinman S, Murphy JR, et al. Screening of single-donor apheresis platelets for bacterial contamination: the PASSPORT study results. Transfusion 2010; 50:589.
- Vamvakas EC. Relative safety of pooled whole blood-derived versus single-donor (apheresis) platelets in the United States: a systematic review of disparate risks. Transfusion 2009; 49:2743.
- Bux J. Transfusion-related acute lung injury (TRALI): a serious adverse event of blood transfusion. Vox Sang 2005; 89:1.
- Silliman CC, Ambruso DR, Boshkov LK. Transfusion-related acute lung injury. Blood 2005; 105:2266.
- Sanchez R, Toy P. Transfusion related acute lung injury: a pediatric perspective. Pediatr Blood Cancer 2005; 45:248.
- Bux J, Sachs UJ. The pathogenesis of transfusion-related acute lung injury (TRALI). Br J Haematol 2007; 136:788.
- Muniz M, Sheldon S, Schuller RM, et al. Patient-specific transfusion-related acute lung injury. Vox Sang 2008; 94:70.
- Eder AF, Herron R, Strupp A, et al. Transfusion-related acute lung injury surveillance (2003-2005) and the potential impact of the selective use of plasma from male donors in the American Red Cross. Transfusion 2007; 47:599.
- Chapman CE, Stainsby D, Jones H, et al. Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma. Transfusion 2009; 49:440.
- WHOM TO CONSULT AND WHY
- GENERAL APPROACH
- PHYSICIAN ROLE
- PATIENT PROFILE
- Special considerations
- FREQUENCY OF TRANSFUSION REACTIONS
- MANAGEMENT OF REACTIONS
- Minor transfusion complications
- Major transfusion complications
- - Hemolysis
- - Fluid overload
- - Bacterial contamination
- - TRALI
- - Anaphylaxis
- EXCLUSION CRITERIA
- SUMMARY AND RECOMMENDATIONS