More than 50% of red cells in the UK are transfused for non-surgical indications. The recipients are often elderly and have an increased risk of transfusion complications such as transfusion-associated circulatory overload (TACO). Although overall red cell demand has fallen in the UK in the last decade, largely because of a reduction in surgical transfusions, there has been a continuing rise in requests for platelets and fresh frozen plasma (FFP).
The decision to transfuse, and how much, should be based on clinical assessment and clearly defined objectives, such as reduction in fatigue, not on the Hb level alone. Evidence-based guidelines improve the balance between efficacy and safety as well as improving the economy of blood use. Alternatives to donor blood should be used where appropriate. The introduction of computerised ordering systems for blood components offers the opportunity to link requests to ‘real time’ laboratory data and provide on-screen decision support to the prescriber based on best evidence for the clinical indication. Inappropriate transfusions have been significantly reduced by the introduction of such systems in certain US hospitals (Murphy et al., 2013).
The biggest medical users of blood are haematology, oncology, gastrointestinal medicine (including liver disease) and renal medicine (National Comparative Audit of Blood Transfusion – 2011 Audit of Use of Blood in Adult Medical Patients – Part 1 http://hospital.blood.co.uk/library/pdf/Medical_Use_Audit_Part_1_Report.pdf). The median age of transfused patients in this audit was 73 years and nearly half were transfused outside current national guidelines. It was found that 20% of patients were transfused despite having a treatable cause for anaemia, such as iron deficiency; 29% were transfused at an Hb concentration above the predefined ‘trigger’; and patients were often transfused up to a higher than necessary Hb concentration (especially patients of low body weight).