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CHR Guidelines for Transfusion

These guidelines were developed by the CHR Regional Transfusion Committee and were approved by the Medical Advisory Board on December 10, 1998. 

Safety of allogeneic transfusion is a concern both for physicians and patients.  Although the risk of transfusion remains low, physicians need to use blood and blood products judiciously to ensure that any attendant risk can be justified by the potential for clinical benefit to the patient.  As a matter of policy the use of allogeneic transfusion should be minimized without compromising patient care by under-transfusing.   Strategies that should be considered to reduce allogeneic blood use in appropriate cases include blood conservation techniques in surgery, autologous transfusion, acute normovolemic hemodilution and the use of a Cell Saver.  Recombinant human erythropoietin may be appropriate in some cases (e.g. to increase pre-operative hemoglobin to acceptable levels in those unwilling to accept transfusion for religious reasons).   The purpose of the guidelines is to promote a consistent and scientifically based pattern of blood use in the Region.  The guidelines will also be used as a basis for transfusion audit.  It is recognized that the guidelines will not necessarily be appropriate in all clinical circumstances and that it is a matter of clinical judgement to ensure that each patient receives the most appropriate treatment.

In 1997, the CMA published guidelines that refer specifically to red blood cell and plasma transfusions only.  Guidelines based on current literature, for the use of other components and plasma protein (fractionation) products have been developed by the Transfusion Committee.  The following CMA Guidelines are endorsed by the Transfusion Committee and form the basis for good transfusion practice.  Italicized script indicates direct quotation from the CMA recommendations.

General

1. Patients should be informed that transfusion of red blood cells, plasma or both is a possible element of the planned medical or surgical intervention and provided with information about the risks, benefits and available alternatives.

2. When feasible, the patient’s consent to a transfusion of red blood cells, plasma or both, should be obtained and recorded in the patient’s medical chart.

3. The physician overseeing the care of the patient should be responsible for obtaining informed consent for red blood cell or plasma administration.

4. Patients should be informed that they have received a red blood cell or plasma transfusion subsequent to its administration.  A Regional policy is pending.

5. A physician prescribing transfusion of red blood cells or plasma should be familiar with the indications for and benefits and risk from the use of these fractions.

6. Documentation that supports the administration of the red blood cells or plasma should be found in the patient's chart.

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