The clinician's approach to the management of risk

Although risk has always been accepted as an integral part of any medical or surgical therapy, it is only in recent years that quantitation of this risk in transfusion medicine is being assessed in a detailed and practical manner. Balancing of the risk/benefit equation in relation to blood component therapy has only become a day-to-day issue in clinical medicine since the recognition that HIV could be transmitted by blood transfusion. Blood transfusion has never been as safe a procedure as most patients and clinicians have thought, with numerous potential complications and new ones being recognized. As medical teaching in blood component therapy has not had a high profile in most undergraduate and postgraduate medical curricula, there has been an inappropriately low level of awareness for the indications for the risks and benefits of blood component therapy. Since the appearance of transfusion-transmitted HIV, clinicians and patients alike have rapidly become aware of the potential risks associated with transfusion medicine. This paper addresses the issues of how the clinician can minimize the risks of blood component therapy and to effectively present the risks and benefits to clinical users and potential recipients of blood component therapy. Paradoxically, in developed countries, transfusion therapy is probably safer than it has ever been in the past, but the perception of the community is the opposite. Why is this so?, and what can be done to improve that patient's perception and associated fear? The ultimate answer rests with improving assessment of risks versus benefits, effective education and communication with the patient (and relatives) in order to achieve meaningful informed consent.