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Risk management in transfusion medicine

1996; Elsevier BV; Volume: 10; Issue: 3 Linguagem: Inglês

10.1016/s0887-7963(96)80059-9

1532-9496

James P. Isbister,

Blood transfusion and management

ISK/BENEFIT analysis is increasingly becoming an integral part of medical practice. As with the rest of society, there is an increasing desire to measure processes and outcomes. The jargon terms of risk/benefit analysis, (bench marking, total quality assurance, quality control, and economic rationalism) are concepts we must accept and live with on a day-to-day basis. However, in the context of this obsession with process and outcomes, we must not lose sight of the fact that clinicians are trying to achieve the best possible results for their patients ever in the context of a capped or reduced economic health environment and increased accountability for services over which they have less and less control. The simplistic view of the economic rationalists concludes that by analyzing and quantifying every part of the process it can be fully understood, and by so doing it is possible to accurately predict and achieve perfect outcomes. This naive approach denies the fact that the whole is greater than the sum of the parts. Many substantial benefits for patients are only achieved where significant risk is involved, often when unpredictable and unmeasurable factors are present. If risk is reduced to a negligible level, the likelihood is that benefit will be jeopardized. However, this is not to say that clinicians must not carefully balance and communicate the risk/benetit equation to their individual patients. Despite extensive understanding of the dangers of homologous (allogeneic) transfusion dating back to the early days of transfusion medicine, it was not until the recognition that human immunodeficiency virus (HIV) can be transmitted by blood transfusion that there has been overwhelming arousal of interest and concern about its hazards. In large measure, consumer pressure and media hype have fueled the controversy. Clinicians are rapidly learning to balance the risk/benefit equation for transfusion therapy for their patients. The days of not carefully considering the indications for blood component therapy are rapidly passing. It is now widely accepted that there must be clearly identified and valid reasons for every transfusion together with a careful appraisal of the potential hazards, informed consent, and appropriate administration and monitoring.