The path to safer home transfusion: Standardized procedures
- Joy L Fridey, MD
Joy L Fridey, MD
- Regional Medical Director
- American Red Cross Blood Services, Southern California
In an effort to increase the accessibility and convenience of care to chronically ill patients and to decrease associated costs, many therapies, including transfusions, are now occasionally given in patients' homes or physicians' offices. There is at least 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.
Another legitimate concern is one that underlies all of transfusion practice: the possibility that blood could be administered to the wrong patient. This phenomenon has been well-documented in tertiary care centers [1-4]. Causes range from mislabeling of the pretransfusion specimen to administering blood to a patient who is wearing either the wrong identification band or none at all. Any of these errors can be duplicated in a home transfusion setting.
Transfusion safety derives from constructing clear standard operating procedures (SOPs), training the personnel who transfuse, and adhering to written procedures. Composing or reading about transfusion SOPs is not a glamorous or engaging enterprise. However, SOPs are the backbone of transfusion safety and, in view of the recent interest that nonhospital facilities and agencies have shown in out-of-hospital transfusions, it is appropriate that practical suggestions for writing SOPs be available.
The procedures that should be written for the main activities associated with home transfusion and the general content of each of these procedures will be reviewed here. This document is intended to provide broad guidelines since 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), now considered an international authority on transfusion practices and processes, also publishes a comprehensive and informative Technical Manual , and every 24 months issues updated transfusion Standards .
This topic reviews the SOPs for home transfusion. 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 PRETRANSFUSION 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