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Recommendations for Transfusion Medicine

Choosing Wisely is a global initiative that seeks to encourage both doctors and patients to have a conversation about the value of treatments. The below recommendations for transfusion medicine are the result of a Choosing Wisely consultation involving the College.  

1. Don't give a patient a blood transfusion without informing them about the risks and benefits (although do not delay emergency transfusion)

Evidence/guidance

There is a lack of high-quality research in this field with largely observational data available. The evidence suggests that patients have a limited understanding of many aspects of transfusion, but that they do want to be part of an informed decision-making process. The evidence also indicates that patients are reassured by the provision of written information.

Patient information\decision aids

A number of patient information materials are available through the NHSBT website

2. Don't transfuse red cells for iron deficiency anaemia without haemodynamic instability

Evidence\guidance

Patient information\decision aids

3. Only consider transfusing platelets for patients with chemotherapy-induced thrombocytopenia where the platelet count is < 10 X 109/L except when the patient has clinical significant bleeding or will be undergoing a procedure with a high risk of bleeding
4. When restrictive thresholds for patients needing red cell transfusions and give only one unit at a time except when the patient has active bleeding

Evidence/guidance

5. Only transfuse O Rh D negative red cells to O Rh D negative patients and in emergencies for females of childbearing potential with unknown blood group