Journal Mobile

LM Manson, GC Preston
Journal Issue: 
Volume 38: Issue 4: 2008




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.