Transfusion medicine update

Abstract

Allogeneic blood transfusion is technically less challenging than solid organ transplantation, but potential adverse events are of similar magnitude. Thus, inappropriate transfusion could be construed as medical malpractice. The Japan Society of Transfusion Medicine and Cell Therapy (JSTMCT) promulgates evidence-based guidelines for each blood product. Guidelines from Japan’s Ministry of Health, Labour and Welfare also exist, and have recently been updated. Papers pertaining to patients up to four months old and reported from 1994 to 2014 were collected and analyzed. Recommendations were weighted according to the strength of each paper’s evidence, with the goal of establishing consensus on three clinical questions: a trigger for red blood cell (RBC) transfusion, a trigger for platelet concentrate (PC) transfusion, and circumstances in which cytomegalovirus-safe (CMV-safe) blood products should be selected. Consensus statements are as follows. A hemoglobin (Hb) trigger for RBC transfusion is Hb 7 g/dL. A platelet count (PLT) trigger for PC transfusion is PLT 20,000–30,000/μL. Circumstances in which CMV-safe blood products should be selected include transfusion in utero until 28 days postpartum when the mother’s CMV titer is negative or unknown. For transfusion after 4 months of age, the standard JSTMCT guidelines for adults should be consulted. Moreover, note that the previous recommendation of a fibrinogen level≤150 mg/dL for fresh frozen plasma transfusion has been revised, and albumin infusion is no longer indicated for a number of conditions previously approved. Technical challenges in solid organ transplantation require teamwork. Although technical challenges may be less in allogeneic blood transfusion, teamwork is just as important, and team members, including physicians, should be well versed in the latest evidence-based transfusion guidelines.