Use and abuse of blood

Area of Science:

• Hematology
• Transfusion Medicine
• Clinical Pharmacology

Background:

• Blood and blood product utilization requires careful consideration to avoid misuse.
• Physicians often incorrectly focus on peripheral blood counts rather than clinical symptoms for transfusion decisions.
• The oxygen-carrying capacity of blood is a more critical determinant of anemia severity than red cell count or hemoglobin levels.

Purpose of the Study:

• To review the appropriate use and identify the abuse of blood and blood products.
• To emphasize evidence-based decision-making for transfusions and blood derivative administration.
• To highlight current needs and future directions for specific blood components and therapeutic agents.

Main Methods:

• Literature review of current practices and guidelines for blood product transfusion.
• Analysis of the rationale behind transfusion decisions for various blood components.
• Evaluation of the established and emerging indications for plasma-derived products.

Main Results:

• Misuse of cell concentrates stems from prioritizing peripheral blood counts over patient symptoms.
• There are no universally "critical" platelet or granulocyte counts necessitating transfusion.
• Albumin and immunoglobulin use is well-defined, yet unjustified administration persists; Factor VIII concentrate demand is rising.

Conclusions:

• Transfusion decisions must be individualized, based on accurate diagnosis and risk-benefit assessment.
• Increased production of cryoprecipitate and safe, virus-free Factor VIII concentrates is needed.
• Further research is required for indications of Antithrombin-III, while specific immunoglobulins, protease inhibitors, and enzyme preparations show growing therapeutic potential.