Guidelines for red blood cell and plasma transfusion for adults and children

Objective: To provide broad guidelines and principles to help physicians, other health care workers and patients make decisions about the appropriateness of red blood cell and plasma transfusion. Options: These guidelines are limited to red blood cell and plasma transfusion in adults and children over 4 months of age. Indications for specific clinical conditions and specialized blood components are not addressed. Options considered included appropriate use of allogeneic and autologous transfusion and substituting non-blood alternatives. Outcomes: Patient well-being, avoidance of risk and appropriate use of the allogeneic blood supply. Evidence: Existing practice guidelines and published research supporting clinical indications for transfusions; a review of the legal and ethical issues pertaining to transfusion practices; physician focus groups to assess current needs in the field of transfusion and counseling practices. Values: Provision of optimum patient care and prudent clinical use of a precious resource, the allogeneic blood supply. Patients should be involved in transfusion decisions whenever possible. Benefits, harms, costs: The risks and benefits of using allogeneic and autologous blood for transfusion were weighed and compared with those associated with non-blood alternatives. Costs, both monetary and non-monetary, were considered when known. Recommendations: The recommendations relate to the dissemination of blood product information, the participatory process of informed consent and the clinical indications for blood product transfusion. Each recommendation was rated based on the strength of the supporting evidence. In brief, patients should be informed about transfusion. Accurate data regarding the risks of transfusion should be available to and used by physicians to inform patients effectively. Red blood cell transfusion, allogeneic or autologous, should be given to increase oxygen carriage in the blood in situations where this is likely to be inadequate. Plasma should be given primarily to support coagulation in the setting of multiple factor deficiencies or for therapeutic plasmapheresis for specific indications. Transfusion committees should function at a local level to assist in the dissemination of information and establishment of prudent transfusion practices. Endorsement: The guidelines are endorsed by the following national associations: Aplastic Anemia Association of Canada, Canadian Anesthetists' Society, Canadian Association of Emergency Physicians, Canadian Association of General Surgeons, Canadian Association of Pathologists, Canadian Blood Agency, Canadian Cardiovascular Society, Canadian Critical Care Society, Canadian Healthcare Association, Canadian Hemophilia Society, Canadian Infectious Disease Society, Canadian Nurses Association, Canadian Orthopaedic Association, Canadian Paediatric Society, Canadian Red Cross Society, Canadian Society for Transfusion Medicine, Canadian Society of Internal Medicine, Canadian Society of Laboratory Technologists, Canadian Transplantation Society, College of Family Physicians of Canada, Patient Alumni Board of the Ottawa Heart Institute, Society of Obstetricians and Gynaecologists of Canada and Trauma Association of Canada. Sponsors: Funding was provided by the Canadian Blood Agency, the Canadian Red Cross Society and Health Canada. The Canadian Medical Association managed the overall project and convened the group of experts who developed the guidelines. The guidelines reflect the views of the scientific experts and should not be seen as an endorsement of the CMA. © 1997 Canadian Medical Association.