Risks from,and appropriate use of,blood products

Abstract

Transfusion medicine has come a long way since the discovery of ABO blood groups by the Austrian scientist Karl Landsteiner in 1900. There has been continual improvement in the quality and safety of blood products available for clinical use, but, as with any treatment, there are associated risks. However, the UK national haemovigilance scheme has shown that most of those related to blood products are due to human error and could be prevented. Indeed, the most frequently reported category of transfusion reaction is ‘incorrect blood component tranfused’, which is nearly always due to an error of patient identification or prescribing, and can be fatal. Junior doctors are most often implicated, as they are delegated responsibility for blood-product prescribing and many mistakes arise due to lack of knowledge. While a lot of media emphasis has been put on the risk of viral and, more recently, prion transmission, transfusion-transmitted infections are very rare. In the UK there have only been four cases of confirmed variant Creutzfeldt-Jakob disease due to blood transfusion, and the risk of HIV transmission is approximately one per four million units transfused. Other problems, such as febrile, allergic and haemolytic reactions, are much more common. The use of red cells, platelets, fresh frozen plasma and cryoprecipitate requires understanding both of their content and of the clinical situations in which they are used. Doctors need to be aware of these issues in order to use blood products appropriately.