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/a>:

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