Recommendations for transfusion medicine
Choosing Wisely is a global initiative that seeks to encourage both doctors and patients to have a conversation about the value of treatments. The below recommendations for transfusion medicine are the result of a Choosing Wisely consultation involving the College.
Recommendation 1: Don't give a patient a blood transfusion without informing them about the risks and benefits (although do not delay emergency transfusion).
Evidence/guidance are lised below.
There is a lack of high-quality research in this field with largely observational data available. The evidence suggests that patients have a limited understanding of many aspects of transfusion, but that they do want to be part of an informed decision-making process. The evidence also indicates that patients are reassured by the provision of written information.
- NICE Guidance: Blood transfusion November 2015.
- NICE Quality Standard: Blood Transfusion December 2016.
Patient information/decision aids are listed below.
- A number of patient information materials are available through the NHSBT website.
- Will I need blood transfusion?
Recommendation 2: Don't transfuse red cells for iron deficiency anaemia without haemodynamic instability.
Evidence/guidance are listed below.
- NICE Guidance: Blood transfusion November 2015.
- Lidder PG et al. Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery – a prospective, randomised, controlled trial. Ann R Coll Surg Engl 2007;89:418–421.
- Luporsi E et al. Evaluation of cost savings with ferric carboxymaltose in anemia treatment through its impact on erythropoiesis-stimulating agents and blood transfusion: French healthcare payer perspective. J Med Econ 2012;15:225–232.
- NICE Quality Standard: Blood Transfusion December 2016.
Patient information/decision aids are listed below.
- Leaflets are available through the NHSBT website.
- Anaemia patient Information leaflet October 2016.
- Iron in your diet.
Recommendation 3: Only consider transfusing platelets for patients with chemotherapy-induced thrombocytopenia where the platelet count is <10 X 109/L except when the patient has clinical significant bleeding or will be undergoing a procedure with a high risk of bleeding.
Recommendation 4: When restrictive thresholds for patients needing red cell transfusions and give only one unit at a time except when the patient has active bleeding.
Evidence/guidance are listed below.
- NICE Guidance: Blood transfusion.
- Cochrane Review: Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion.
Recommendation 5: Only transfuse O Rh D negative red cells to O Rh D negative patients and in emergencies for females of childbearing potential with unknown blood group.