The path to safer home transfusion: Standard operating procedures
- Joy L Fridey, MD
Joy L Fridey, MD
- Regional Medical Director
- American Red Cross Blood Services, Southern California
To increase the accessibility and convenience of care to chronically ill patients and potentially decrease cost, many therapies, including transfusion, are now provided in a patient's home or other non-hospital settings. There is at least one major factor that distinguishes the administration of blood in a home setting from transfusion in a hospital or other healthcare facility: decreased availability of emergency medical care and immediate diagnostic tests should a potentially serious complication occur. This inherent difference compounds the usual risks of transfusion.
An additional safety concern is the ever-present possibility that blood could be administered to the wrong patient, resulting in a severe hemolytic transfusion reaction. Mis-transfusion has been well-documented in tertiary care centers [1-4]. Causes range from mislabeling of the pre-transfusion specimen to administration of blood to a patient wearing either the wrong identification band or none at all. Any of these errors can occur in a home transfusion setting. (See "Approach to the patient with a suspected acute transfusion reaction", section on 'Acute hemolytic transfusion reaction (AHTR)'.)
Transfusion safety derives from the development of standard operating procedures (SOPs) based on applicable regulations and blood banking standards; training and proficiency of personnel who transfuse; and adherence to written procedures. Writing or reading transfusion SOPs may not be a particularly interesting aspect of the transfusion process, but SOPs are the backbone of transfusion safety. Because of interest that non-hospital facilities and agencies have shown in out-of-hospital transfusions, this article offers information to assist in the development of SOPs for home transfusion.
Procedures for the main activities associated with home transfusion and general content will be reviewed here. This document is intended to provide broad guidelines; a comprehensive discussion of all possible procedural details is beyond the scope of this overview. Additional information is available in several reviews [5,6]. The AABB (formerly the American Association of Blood Banks) is an international authority on transfusion practices and procedures and publishes an excellent resource for transfusion medicine and blood banking, the AABB Technical Manual, which is regularly updated, as are the AABB standards for blood banks and transfusion services [7-9].
The general principles of home transfusion, including the patient profile, exclusion criteria, physicians’ roles, and the management of transfusion reactions are discussed separately. (See "General principles of home blood transfusion" and "Immunologic transfusion reactions".)
- Baele PL, De Bruyere M, Deneys V, et al. Bedside transfusion errors. A prospective survey by the Belgium SAnGUIS Group. Vox Sang 1994; 66:117.
- Sazama K. Reports of 355 transfusion-associated deaths: 1976 through 1985. Transfusion 1990; 30:583.
- Linden JV, Paul B, Dressler KP. A report of 104 transfusion errors in New York State. Transfusion 1992; 32:601.
- Renner SW, Howanitz PJ, Bachner P. Wristband identification error reporting in 712 hospitals. A College of American Pathologists' Q-Probes study of quality issues in transfusion practice. Arch Pathol Lab Med 1993; 117:573.
- Benson K. Home is where the heart is: do blood transfusions belong there too? Transfus Med Rev 2006; 20:218.
- Fridey JL. Practical aspects of out-of-hospital transfusion. Am J Clin Pathol 1997; 107:S64.
- Technical Manual, 18th edition, Fung M, Grossman BJ, Hillyer CD, et al. (Eds), AABB Press, Bethesda, MD 2014.
- Standards for Blood Banks and Transfusion Services, 30th edition, AABB, Bethesda, MD 2016.
- AABB, the American Red Cross, America's Blood Centers, and the Armed Services Blood Program. Circular of Information for the Use of Human Blood and Blood Components, Revised November 2013. Available online at: https://www.aabb.org/tm/coi/Documents/coi1113.pdf (Accessed on December 20, 2016).
- Snyder EL. Component selection: The role of leukocyte reduction. In: Component Selection: Polemics and Politics, Fridey JL, Simpson MB (Eds), American Association of Blood Banks, Bethesda, MD 1996.
- Belloni M, Alghisi A, Bettini C, et al. Hypotensive reactions associated with white cell-reduced apheresis platelet concentrates in patients not receiving ACE Inhibitors. Transfusion 1998; 38:412.
- http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm320636.htm (Accessed on February 02, 2017).
- Lavee J, Paz Y. Hypotensive reactions associated with transfusion of bedside leukocyte-reduction filtered blood products in heart transplanted patients. J Heart Lung Transplant 2001; 20:759.
- Sreelakshmi TR, Eldridge J. Acute hypotension associated with leucocyte depletion filters during cell salvaged blood transfusion. Anaesthesia 2010; 65:742.
- Douglas L. Out-of-hospital transfusion: Home transfusion therapy programs. In: Out-of-hospital Transfusion Therapy, Fridey JL, Kasprisin CA, Issitt LA (Eds), American Association of Blood Banks, Bethesda, MD 1994.
- COLLECTION AND LABELING OF PRE-TRANSFUSION SPECIMENS
- SITE ASSESSMENT
- ISSUING OF BLOOD
- Packed red blood cells and plasma
- TRANSPORTING AND STORING BLOOD COMPONENTS
- PATIENT IDENTIFICATION
- MANAGEMENT OF COMPLICATIONS
- VALIDATION AND REVIEW
- SUMMARY AND RECOMMENDATIONS