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Hanbook of pediatric transfusion medicine - part 9

Phản ứng truyền máu tán huyết cấp tính truyền trẻ em ít phổ biến hơn ở người lớn truyền. Khi so sánh con số tuyệt đối của các phản ứng nghiêm trọng, truyền rất ít được trao cho trẻ em hơn người lớn người nhận | 318 Jed B. Gorlin TABLE 27.1 Relative Risks of Transfusion Complications Per Unit Risk Risk Ratio Reference Hepatitis C 1 1 600 000 Busch 2001 hiV 1 1 900 000 Busch 2001 Wrong blood in tube 1 1000 Dzik et al. 2002 Wrong recipient of auto unit 1 16 000 Linden et al. 2000 TRALI 1 5000 Papovsky 2001 Metabolic reaction neonate 1 1000 Stranss 2000 Hemolysis from ABO-incompatible plasma in an apheresis platelet 1 10 000-46 000 Mair and Benson 1998 Larsson et al. 2001 TRALI Transfusion-related acute lung injury. adherence to specimen labeling guidelines Linden et al. 2000 Lumadue et al. 1997 Cursio and Fountas 2002 . The most risk-free transfusion of course is the one that never happens. Hence it is imperative to consider whether each and every transfusion is truly indicated. All transfusion service medical directors can recall an anecdote of a transfusion complication that followed a transfusion of dubious clinical necessity or value. Transfusing multiple units of fresh frozen plasma FFP to correct minimally prolonged coagulation parameters or platelets before a minimally invasive procedure are examples Dzik 1999 . Special transfusion requirements are generally far more apparent to the ordering physician than the blood bank personnel. Ordering staff often know far more about the specific patient needs for example requirements for cytomegalovirus CMV reduced risk or irradiated components than the blood bank which may have no prior transfusion history on a patient at increased risk for some transfusion complication. While blood bank personnel are available for consultations it is imperative to minimize risks by ensuring that the ordering physician selects the optimal type and quantity of transfusible component. Furthermore the mechanisms in place to issue those components to the patient must ensure proper storage and handling and proper identification of the patient to be transfused. Finally the system used to infuse the actual components must be fully validated and the .