Good blood management
There are some situations when transfusion is essential, but for many patients the need for transfusion can be reduced or avoided. We have defined good blood management as ‘management of the patient at risk of transfusion to minimise the need for allogenic transfusion, without detriment to the outcome’.
Who are the patients who are transfused?
Recent surveys of the population that receives red cell transfusions in the UK show that most blood recipients are relatively elderly; many will have cardiovascular disease and may be less tolerant of low haemoglobin levels than younger, fitter patients. It may be unwise to set a very low transfusion threshold for such patients. However, they may also be at greater risk of congestive cardiac failure due to volume overload when blood and other fluids are infused.
Young patients who require transfusion are more at risk of long-term complications, so special attention should be given to minimising the need for transfusion and avoiding known or potential risks. Premature neonates are frequently transfused and are at high risk of identification errors.
Medical or surgical?
This section deals with transfusion of patients seen in the surgical setting. Section 4 focuses on the medical context. However, with an ageing population such as that in the UK, many patients who receive blood transfusions have both medical and surgical problems and undergo treatment for both.