Guidelines for red blood cell and plasma transfusion for adults and children
Ideally, practice guidelines are intended to assist practitioners and patients to make decisions about appropriate health care.1 They are not intended to provide a rigid prescription for care. Guidelines should be discussed, adopted or modified according to local clinical needs and constraints.
Why do we need Canadian guidelines for red blood cell and plasma transfusion?
Many available guidelines are outdated, because the science and the blood system have changed dramatically in the last decade. Some guidelines reflect values that are not relevant to Canada; others rely heavily on "expert" opinions rather than critical review of evidence. Although in some areas of transfusion inadequate scientific evidence exists and "expert" opinions are necessary, in other areas sufficient evidence exists and should be used to generate recommendations. As well, some guidelines deal only with surgical populations; for other populations, patients with chronic anemia and, particularly, children, guidelines do not exist.
The great many publications on transfusion medicine in the last decade require synthesis and interpretation. New blood programs, such as autologous predeposit and intraoperative cell salvage, lack criteria for best integrating them into the predominantly allogeneic system. Critical evaluation of current transfusion practices in Canada may lead to new perspectives in clinical decision-making and applying new information and new choices.
Those generating guidelines have certain values that influence how the evidence is reviewed and the guidelines are elaborated. Two principles guided the Expert Working Group (EWG): the guidelines should permit optimal patient care while fostering prudent clinical use of the precious allogeneic blood supply. The EWG considered avoidance of transfusion to be ideal to the extent that avoidance was not likely to be a more serious risk than the transfusion. In addition, the members believe that, whenever possible, patients should be involved in transfusion decisions.
| CMAJ June 1, 1997 (vol 156, no 11)
/ JAMC le 1er juin 1997 (vol 156, no 11) |
CPG Infobase / Infobanque des GPC
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