[Indications and utilization of labile blood products]

FUNDAMENTAL PRINCIPLES: Rigorous prescription of labile blood products is a fundamental step in assuring safe transfusion. The clinician must avoid all unnecessary transfusions and choose the most adapted blood product to meet the patient's clinical requirements. TRANSFUSION THERAPY: The patient's immunological situation, past history, prognosis, and potential need for future transfusions must be taken into account in a global approach aimed at determining which transfusion product is most adapted for each individual patient. PACKED RED CELLS: Packed red cells should be prescribed after evaluating the risk of tissue hypoxia in light of the patient's clinical situation. Restrictions on transfusion should be particularly drastic if the anemic state could respond to specific treatment (vitamin B12, iron, folic acid, erythropoietin). PLATELETS: There has been considerable development in platelet transfusion over the last few years, particularly in onco-hematology. Nevertheless, very few clinical studies are available for determining which cases require curative transfusion (solely in case of blood loss) and which situations require preventive transfusion (standard versus apheresis products). The platelet threshold indicating transfusion remains a subject of wide debate. FROZEN FRESH PLASMA: In France, regulatory indications for frozen fresh plasma were established by a ministerial decree and concern situations where a plasma fraction substitution product (medically derived blood product) cannot be prescribed. WHITE BLOOD CELL: The transfusion of this type of product should be reserved for clinical situations determined on a consensus basis between clinicians and hemobiologists.