Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Related Searches

The path to safer home transfusion: Standardized procedures

INTRODUCTION

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 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 [7], and every 18 months issues updated transfusion Standards [8].

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".)

              

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: May 2013. | This topic last updated: May 21, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. 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.
  2. Sazama K. Reports of 355 transfusion-associated deaths: 1976 through 1985. Transfusion 1990; 30:583.
  3. Linden JV, Paul B, Dressler KP. A report of 104 transfusion errors in New York State. Transfusion 1992; 32:601.
  4. 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.
  5. Benson K. Home is where the heart is: do blood transfusions belong there too? Transfus Med Rev 2006; 20:218.
  6. Fridey JL. Practical aspects of out-of-hospital transfusion. Am J Clin Pathol 1997; 107:S64.
  7. Technical Manual, 17th ed, Roback JD, Combs MR, Grossman BJ, Hillyer CD (Eds), American Association of Blood Banks (AABB), Bethesda, MD 2011.
  8. Standards for Blood Banks and Transfusion Services, 27th ed, American Association of Blood Banks, Bethesda, MD 2011.
  9. 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.
  10. 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.
  11. www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm062284.htm (Accessed on March 22, 2010).
  12. 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.
  13. Sreelakshmi TR, Eldridge J. Acute hypotension associated with leucocyte depletion filters during cell salvaged blood transfusion. Anaesthesia 2010; 65:742.
  14. 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.