General principles of home blood transfusion
- Joy L Fridey, MD
Joy L Fridey, MD
- Regional Medical Director
- American Red Cross Blood Services, Southern California
Traditionally, blood transfusions have been administered either in hospitals or outpatient clinics. To increase the accessibility and convenience of care to chronically ill patients and potentially decrease associated costs, many therapies, including transfusions, are occasionally provided in patients' homes or physicians' offices. The indications for home blood transfusion are similar to those in other health care settings. (See "Red blood cell transfusion in adults: Storage, specialized modifications, and infusion parameters".)
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 for managing serious complications. This inherent difference compounds the usual and sometimes serious risks of transfusion. Thus, patient safety is a higher priority than increased convenience and any cost savings that may be realized in home-based therapies.
Important aspects of home transfusion will be reviewed here, with a focus on recipient safety. Several key references that should be consulted prior to setting up a home transfusion program will be mentioned.
Standardized procedures for maximizing the safety of home blood transfusion are presented separately. (See "The path to safer home transfusion: Standard operating 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 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 health care provider or agency that does not have transfusion procedures meeting regulations and industry standards.
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- A Compendium of Transfusion Practice Guidelines, 3rd ed, Fridey JL, Marcus L (Eds), American Red Cross, 2017.
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- WHOM TO CONSULT AND WHY
- GENERAL APPROACH
- PHYSICIAN ROLE
- PATIENT PROFILE
- Special considerations
- FREQUENCY OF TRANSFUSION REACTIONS
- MANAGEMENT OF REACTIONS
- Minor transfusion complications
- Major transfusion complications
- - Hemolysis
- - Fluid overload
- - Bacterial contamination
- - TRALI
- - Anaphylaxis
- EXCLUSION CRITERIA
- SUMMARY AND RECOMMENDATIONS