Literature Review

Introduction

There has been much debate within the peri-operative environment at a regional New South Wales hospital regarding the management and transfusion of red blood cells. This is why the topic has been selected for further study. The purpose of this paper is to review the literature surrounding the safety of red blood cell (RBC) transfusions, which comes under standard seven of the National Safety and Quality in Health Service Standards (ACSQHC, 2012). It will touch on the complications of RBC transfusion, when to transfuse, the management of blood loss and the impact of RBC transfusion on critically ill patients. The paper will aim to answer the following questions: ‘To transfuse or not to transfuse, do the risks of transfusion outweigh the benefits?’ It will also examine and critically analyse strategies that have been put in place to reduce errors in the administration of blood and also strategies aimed at reducing blood loss and therefore decrease the chance of a patient needing to be transfused. Similarities, differences and omissions of each research article will be examined. The relevance of these issues to the peri-operative environment will be evaluated, and conclusions and recommendations will be made.

In the peri-operative environment, red blood cells transfusions are used to treat haemorrhage and to improve oxygen delivery to tissue. Approximately 85 million red blood cell units are transfused annually worldwide (American Association of Blood Banks, 2012). They are seen to have remarkable health benefits for patients and have undoubtedly saved the lives of thousands of people. Unfortunately, there is considerable risk involved. The leading cause of RBC related mortality is transfusion-related acute lung injury (TRALI), ABO and non-ABO haemolytic transfusion reactions (HTR) and transfusion related sepsis (TAS). Inappropriate or incorrect transfusion of RBC is the most frequent cause for HTR. Errors can arise from donor choice, laboratory and

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