Key points
• Some patients (Jehovah's Witnesses, for example) refuse blood transfusions due to their religious convictions.
• It will be extremely difficult for the surgical and anaesthetic teams to do major surgery without using blood. Patients who refuse blood or blood products should be informed of all of their options.
• Avoid unnecessary large volume blood samples
• Plan optimal anaesthetic approach
• Consider cell salvage if feasible/appropriate
• Consider surgical options aimed at minimising blood loss
• Optimise patients prior to surgery (anaemia management)
Rationale
A thorough Health Care Advance Directive (Living Will) is frequently executed by JW, and many of them carry an "advance directive" that forbids blood transfusions.
Links to resources (where available)
Key points
• Blood supply issues – risk of blood shortages
• Plan contingency local guidelines – staff/product
• Priority/patient priority
Rationale
During prolonged extreme shortages, blood centres and transfusion services must alter practices to meet the needs of patients. [refer to local guidelines where available]
Key points
Patient blood management
• Evidence-based, multidisciplinary approach to caring for patients who might need a blood transfusion
• Encompasses all aspects of the transfusion decision-making process, beginning with the initial patient evaluation and continuing through clinical management.
• Aim is for optimal patient outcomes, while maintaining the blood supply to guarantee that blood components are available for patients when they are needed.
Rationale
For the learner to better understand both the decision to transfuse and the alternatives (where available locally).
The urgent need to implement patient blood management: policy brief (who.int)
Patient Blood Management (aabb.org)
BloodSafe eLearning Australia (bloodsafelearning.org.au)
Patient Blood Management Guidelines | National Blood Authority
Patient Blood Management Resources | The International Society of Blood Transfusion (ISBT) (isbtweb.org)Specialist patient groups
1. Children & neonates
Transfusion for children and neonates is not the same as adults. Consider:
• Volumes required (mL s per kg)
• Special components for neonates
• Coagulation ranges [local laboratories]
• Management of transfusion reactions
• Know the triggers in children and neonates
• Management of anaemia in this group
Rationale
Specific transfusion information should be given when delivering education to resident doctors working with these specific patient groups.
Links to resources (where available)
Transfusion for Fetuses, Neonates and Older Children (b-s-h.org.uk)
Add guidelines for specific groups triggers
Specialist patient groups
2. Obstetrics
• Pre- natal screening including maternal RhD status and maternal antibodies
• RhD prophylaxis/treatment
• Risk of and management of postpartum haemorrhage
• Triggers in obstetric haemorrhage
• Anaemia management
Rationale
Specific transfusion information should be given when delivering education to resident doctors working with these specific patient groups
Links to resources (where available)
Blood Grouping and Antibody Testing in Pregnancy (b-s-h.org.uk)
Specialist patient groups
3. Trauma & emergency medicine
• Transfusion of patients with no known blood group – use of emergency components
• Management of massive haemorrhage
• Ongoing transfusion support in trauma patients
Rationale
Links to resources (where available)
Specialist patient groups
4. Haemoglobinopathy patients
• Every patient with sickle cell disease (SCD) and thalassemia should have an extended RBC phenotype utilising a pre-transfusion specimen. Ideally, this should be done during the first year of life, prior to the initiation of a regular transfusion regimen.
• Prior to each transfusion, it is essential to do a complete cross-match and antibody screen for any newly acquired antibodies.
• Components provided must be phenotype matched
• For SCD and thalassemia patients, it is advised to provide fresh units (less than 7–14 days old) to lessen the frequency of transfusions.
Rationale
In order to guarantee uniform standards of care, local recommendations and guidelines are necessary for blood transfusion to Hemoglobinopathy individuals
Links to resources (where available)
