Safety Of Blood Transfusion A Literature Review By Tanjeena Chowdhury

As expected, with war comes extensive injuries. During WWI, it took a wounded soldier about 24 hours to travel from the battlefield to a hospital. Many times, the soldiers did not live through that excruciating 24 hours. The wounds inflicted on many soldiers led to the development of new medical techniques and improvements (iWonder 2015). The quickly rising death toll during WWI led to the creation of blood transfusion techniques. Prior to WWI, blood transfusions were nearly impossible without cross-matching blood types. An article published by Medical History argues that, “Though the technique (blood transfusions) caused several deaths, it did save dozens of other men, proving its lifesaving

During this time, I realized that what I learned in simulation allowed for me to better understand the practices associated with Joe’s blood transfusion and its importance in maintaining his health and safety. I then thought about his nurse’s practice and perceived that she followed what I was perceived as best practice when completing the necessary pre-transfusion checks and talking to him about the procedure. This reflection thereby reinforced to me the importance of following best practice in my future when preforming a blood transfusion, or any patient care for that matter. As many nurses do not follow best practice with transfusions, the importance of addressing pre-transfusion checks, reviewing blood type compatibility, and recognizing the responsibilities that I have from the point of initiation to after completion was further reinforced (Hijji, Parahoo, Hussein, & Barr,

The market of human blood transfusions is broken down into different uses: Elective Surgery, Emergency Surgery and Trauma. However, Hemopure seems to be suitable only for trauma cases due to its characteristics and, again, high price. To understand the reason, it is important to notice that, actually, only 10% of the 500,000 trauma victims receives RBCs “in the field” or at the site of accident, and the remaining 95% of these people does not receive transfusions until they arrive at the hospital. This delay was often cited as a major factor to the 20,000 trauma deaths. Therefore, since the expected market share for Biopure is 25% and assuming that the total blood transfusions remain stable, the potential market size for Hemopure is approximately $350,000,000. This size is based on an average price of $700 multiplied by 2,000,000 units (around 4 blood units are needed for each Trauma case).

For the purposes of this paper, the author will only focus on National Patient Safety Goals 01.01.01: Identifying patients correctly and 01.03.01 Eliminate transfusion errors related to patient misidentification.

The Oxyglobin and Hemopure substitutes developed by Biopure have an advantage over blood transfusions in many areas including blood type matching, universality in terms of donating, such as O+ blood recipients. The blood substitutes also had a much longer storage life of 2 years as opposed to the 6-week storage life of transfused blood. Furthermore, with the rise of diseases such as AIDS and increasing public concern about the same, blood substitutes also helped mitigate that risk. Baxter International and Northfield Laboratories-products sourced their blood substitutes from human blood whereas, Biopure sourced it from animal blood, cattle in particular. This put them in a better position than their competitors. Also Biopure’s Hemopure and Oxyglobin did not require refrigeration unlike its competitor’s products.

In 1667, Jean-Baptiste Denis from France reported transfusing blood from lambs into human, which was later declared illegal. An American physician, from Philadelphia, performed the first human to human blood transfusion but did not report it when he did so in 1795. James Blundell, a british obstetrician, successfully performed a transfusion for a patient with postpartum hemorrhage in 1818 and later performed 10 more and half were successful. In 1840, Samuel Armstrong Lane helped with the first transfusion to treat hemophilia and in 1867, and English surgeon named Joseph Lister used antiseptics to reduce the risk of infections during transfusions. In 1900 an Austrian physician discovered the first 3 human blood groups, A, B, and C that was later renamed O. Hepatitis B was found in blood n 1971 so testing on donor blood began and in 1985, the first blood screening test for HIV was licensed and used in blood banks around the world to protect the supply of blood.

A blood transfusion is the act of giving red blood cells to a patient through an IV.

In a publication of the Stanford University School of Medicine, held an article entitled “Against the Flow—What’s Behind the Decline in Blood Transfusions?” The author of that article, Sarah C. P. Williams, stated: “Over the past decade, a growing body of research has revealed that in hospitals around the world, donated blood is used more often, and in larger quantities, than is needed to help patients—both in operating rooms and hospital

Blood transfusions can be defined as medical procedures that is used by medical professionals and often saves lives. During a blood transfusion, a health professional transfers donated blood to an affected patient’s body. Blood transfusions have made it possible for many individuals to be alive. These medical procedures have impacted the field of medicine in both a positive and a negative manner. Blood transfusions have benefited the world because they have made many medical procedures be possible.

Since there is a severe blood loss, a blood transfusion should be considered when life-threaten, which need a blood test to get the correct blood type of the patient first. However, due to the patient’s belief in such a case, that the patient is not competent to make an informed decision and there is no immediately contactable family or friends, the medical practitioner can treat the patient according to a professional judgment of the patient’s best interests (Legal and Regulatory Services.2005.), or discuss possible treatment options with Hospital Liaison Committee (Australian Red Cross Blood

During emergency moments, patients vary in their choice to receive blood transfusions. Fundamentalist Jehovah's Witnesses are not willing to receive blood products under any circumstances, even when it means losing their lives. Their position is so extreme that they are also not willing to receive a transfusion for their underage children, even those not born yet. However, Ecumenist suggests that secondary components of the blood, such as albumin, coagulation factors and immunoglobulins, should be accepted because they naturally cross the placental barrier during pregnancy, so they do not have the same connotation of the primary components and are no longer considered “blood”. Also, Ecumenist are flexible to those members who receive a transfusion against their will or those who have accepted the transfusion and regret of their actions (Besio). Because of ecumenist’s efforts, Jehovah’s Witnesses are allowed to carry a signed and witnessed “Advance Decision Document” listing the blood products and autologous procedures that are, or are not, acceptable to them. Usually, a copy of that document is placed in the patient records (JPAC). Moreover, ecumenist movements have made it possible for Jehovah’s Witness patients to undergo otherwise religiously questionable procedures such as apheresis, hemodialysis, cardiac bypass with non-blood fluids, as well as the use of recombinant products, like erythropoiesis stimulating agents and granulocyte colony stimulating

A number of psychological theories have been used to explore the factors associated with the behaviors of healthcare practitioners, the theory of planned behavior, social cognitive theory, psychological egoism, and etc., These theoretical domains offer a comprehensive list of potentially relevant constructs for the behavior of transfusing (Haack, 2012). They include factors such as local protocols, management policies, resources, and etc,. Blood transfusion is an essential part of healthcare and can improve patient outcomes, however, like most therapies, it is also associated with significant clinical risks. According to scholarly article, “The Ethics of Consent: Theory and Practice,” written by Franking Miller and Alan Wertheimer, it states

Of course transfusion was associated with haemoglobin criteria on admission (p=0.001), and the quantity of packed red cells given was also associated with haemoglobin grouping on admission (p70 g/L that received blood transfusions for upper GI bleeding, suggesting that some physicians are initiating blood transfusions with a more liberal strategy in some circumstances. Given the recent evidence finding that blood transfusions can contribute to increased morbidity and mortality in patients, there are grounds for this audit to be expanded and continued to determine the results of a fuller and in-depth cohort to understand the reasons behind liberal strategies for initiating blood

TEG/ROTEM has potential savings in reducing blood product administration through development of TEG/ROTEM directed transfusion algorithms. This tailored approach towards blood production resuscitation can minimize excess transfusions. This could ultimately decrease transfusion-related complications and reduce ICU and total hospital day stays.

The traditional process for transfusions has been widely acknowledged as a successful part of the medicinal process, but most people are unaware of the shortcomings of blood transfusions. For example, donated blood is only useful for a maximum of forty-two days of shelf-life, even with the use of nutritional additives. (Lowe 1) Although the demand for blood can be high at times, it is unpredictable how much will be needed or of what blood type. This means that a good amount of blood will inevitably have to be discarded without being used. An ideal blood substitute would have a long shelf life, so that it could be used without waste. The most current artificial bloods have a shelf life of about a year, about eight times traditional blood (Sakar). Another downfall of traditional transfusions is the struggle for compatibility and donor safety. Each donor and recipient match must be tested for blood type and by cross matching blood samples. Not enough people donate blood in the first place, and each person must be tested to make sure that they are disease free, or have not done anything risking their blood’s health in the past. Artificial blood would be a perfect match with all blood types and bodies, eliminating the need for the hassle of having to use donors altogether. (Nielson) An alternative to traditional blood would allow certain groups of people with religious restrictions, such as