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.