Safe and appropriate use

Blood transfusion is an essential part of modern health care. Used correctly, it can save life and improve health. However, as with any therapeutic intervention, it may result in acute or delayed complications and carries the risk of transmission of infectious agents, such as HIV, hepatitis viruses, syphilis and Chagas disease.

The inappropriate use of blood and blood products, coupled with the transfusion of unscreened or improperly screened units, particularly in countries with poor blood programmes, increases the risk of TTIs to recipients. It also widen the gaps between supply and demands and contributes to shortages of blood and blood products for patient requiring transfusion. Thus, it is necessary to reduce the unnecessary transfusions. This can be achieved through the appropriate clinical use of blood, avoiding the needs for transfusion and use of alternatives to transfusion. The transfusion is deemed appropriate when it is used to treat condition leading to significant morbidity and mortality that cannot be prevented or managed effectively by other means. The commitment of the health authorities, health care providers and clinicians are important in prevention, early diagnosis and treatment of diseases/ conditions that could lead to the need for blood transfusion.

Key elements of effective clinical use of blood

Consistently effective clinical transfusion practice cannot be achieved unless the following elements are in place:

• well organized blood programme, coordinated at national level to guarantee safe, adequate and timely supply;
• a national blood policy that addresses the clinical use of blood, with appropriate supportive legal frameworks;
• a national committee on the clinical use of blood and hospital transfusion committees at local level to implement, regularly review and update the national policy and guidelines;
• national guidelines on the clinical use of blood to aid prescribers of blood in their clinical decisions about transfusion, based on systematic reviews of evidence on clinical effectiveness. The development of these guidelines requires involvement of blood prescribers from different clinical disciplines working together with the blood transfusion services. These guidelines should suit local situation;
• the availability of simple alternatives for transfusion (crystalloids and colloids) for the correction of hypovolaemia, and pharmaceuticals and medical devices to reduce blood loss;
• the education and training of clinician, nurses and blood transfusion service staff involved in the transfusion process;
• monitoring and evaluation of the implementation of the national policy and guidelines and the use of monitoring data in quality improvement and education programme to assist clinicians to improve their practice.

Activities

In order to support Member States in developing systems for appropriate use of blood and to reduce unnecessary transfusion, WHO has produced a series of recommendations, guidelines and learning materials, including Recommendations on Developing a National Policy and Guidelines on the Clinical Use of Blood and a module of interactive learning material, The Clinical Use of Blood.

The recommendations provide assistance to Member States in developing and implementing national policies and guidelines and ensuring active collaboration between the blood transfusion service and clinicians throughout the management of patients who may require transfusion. They emphasize the importance of education and training in the clinical use of blood for all clinical and blood bank staff involved in the transfusion process.

The learning material includes a comprehensive module that can be used in undergraduate and postgraduate programmes, in-service training and continuing medical education programmes or for independent study by individual clinicians and blood transfusion specialists, as well as a pocket handbook which summarizes the information contained in the module and has been produced for quick reference by clinicians who need to make urgent decisions on transfusion.

The WHO- HQ in collaboration with the regional offices also has carried out global and regional workshops on promotion of appropriate clinical use of blood in the African, American, Eastern Mediterranean and South East Asian Region as well as national workshops in China and India. These promoted the development of national policies and guidelines on transfusion, the establishment of hospital transfusion committees and haemovigilance systems, the incorporation of transfusion medicine into medical and nursing school curricula and the development of education and training programmes for physicians, nurses and other prescribers of blood. WHO also provides country support in the development and implementation of transfusion guidelines, the establishment of hospital transfusion committees and the training of clinicians.

Related documents

Clinical Use of Blood-Information sheet

The Clinical Use of Blood in Obstetrics, Paediatrics, Surgery & Anaesthesia, Trauma & Burns. Module

The Clinical Use of Blood Handbook

Recommendations on Developing a National Policy and Guidelines on the Clinical Use of Blood