Guidelines for Transfusion: A Way to Decrease Transfusion

SUMMARY Transfusion practice must be audited to comply with regulatory and quality standards. The Joint Commission on the Accreditation of Healthcare Organizations requires evaluation of transfusion practice as a part of continuous quality improvement. Transfusion guidelines are written by each institution, usually by a blood utilization committee, and then reviewed by the committee, which is composed of transfusion medicine and peer members. These guidelines should contain criteria that would make a transfusion easily justified without further investigation. In addition, they should include clinical criteria that render transfusion appropriate, even if the proscribed triggers are not met. Guidelines serve as a means of evaluating transfusion practice, not as transfusion indications. In addition to concerns about transfusion transmitted disease, there are also growing numbers of reports of increased morbidity and mortality due to transfusion itself, which is known to mediate inflammatory cytokines. With new safety measures, regulatory requirements and changes in demographics, there are less eligible donors, resulting in concerns over the adequacy of the blood supply. With the long potential life span of pediatric patients, preventing adverse transfusion outcomes that could have long‐term consequences is important. There are a variety of pharmacologic agents and new technologies available to decrease the need for blood products, reducing risks from transfusion, while preserving the supply of banked blood. Transfusion guidelines are an integral component of any program to help an institution evaluate how well it adheres to acceptable, safe practice. There are many publications written by expert consensus panels that set down adult transfusion audit guidelines and a few that specifically address pediatric guidelines. Unfortunately, there is a paucity of evidence‐based data in the pediatric transfusion literature. This paper will look at data to support the use of conservative transfusion practice and then discuss the creation of guidelines and how they can help, in a comprehensive program, to decrease or even abrogate the use of blood products. Where specific data for pediatric transfusion exists, it will be presented.