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 blood transfusion reactions".)
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- 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