[Specific hazards of transfusion in medical units]

In France, more than 1100 hospitals have medical wards with specialty units that perform transfusions and use about 40% of all labile blood products. Due to patients suffering from multiple pathologies, repeated transfusions or use of platelet concentrates, these hospital units encounter specific and more frequent transfusion hazards than other wards. The incidence rate of transfusion associated cardiac overload, anti-erythrocyte, -HLA or -HPA allo-immunisations or transfusion-induced hemochromatosis, is high. Platelet concentrates may also cause severe allergic reactions. They are still under-reported, though immediate or delayed effects on patients or care processes are considerable. The prevention of these adverse reactions or of their consequences requires careful prescription, properly planned and organised patient stays, particularly at the day hospital, with special attention to coordination of doctors and nurses. Labelling errors of blood group samples or blood administration to the wrong patient are the most frequent serious adverse events. Main underlying causes are: a poor understanding of specific hazards of transfusion in medical wards, routine, multiple transfusions and permanent or occasional working overload. So, both doctors and nurses should do their best to improve organisation and systematically comply with good clinical practice.