In the past few years there has been increasing concern about blood transfusion safety. Avoidable transfusion errors, mostly in patient identification, remain a serious cause of injury and death. There is also heightened awareness of the risk of transmission of viral and bacterial infections. Of particular concern in Britain is the (theoretical) possibility of transmission of variant Creutzfeldt-Jakob disease.
This review puts these risks in perspective (table) and describes the new measures that have been introduced to improve blood safety. It also describes changes in attitude and practice that will affect users of blood in all disciplines, including general practitioners advising patients of the pros and cons of transfusion. Finally it emphasises the need for careful education and training of all those involved in blood prescribing and blood component administration.
- Human error is a cause of transfusion related morbidity and mortality: these errors are entirely avoidable
- The adoption of a lower “transfusion trigger” is gaining acceptance
- Whether or not variant Creutzfeldt-Jakob disease is transmissible by transfusion, it may have a considerable impact on availability of blood for transfusion
- Concerted efforts must now be made to reduce inappropriate blood use and to use alternatives and blood sparing agents
- Pilot studies of barcode patient identification systems are assessing their feasibility in various clinical settings
- Phase III clinical trials of blood substitutes (haemoglobin solutions and perfluorocarbons) are in progress