Rational use of blood: how to do it?

Transfusion medicine is a complex process that depends on several professionals. To do it safely, each professional depends not only on their own knowledge and skills, but also the knowledge and skills of the entire team and the efficiency of the system. There is growing recognition of adverse events associated with blood transfusions and several factors may contribute to increase the chances of a patient suffering transfusion-related complications. These factors include the type of component being transfused, the characteristics and clinical conditions of the patient, the use of inadequate equipment, inconsistent intravenous solutions, inadequate procedures and errors or omissions on the part of the team that provides care to the patient (clerical errors), in particular, in the identification of the patient and blood samples (1). With the goal of increasing the safety of blood transfusions, the majority of countries have specific legislation regulating transfusion medicine in their countries and regions covered. The RDC 57/ANVISA (2) and Ordinance 1353/MS (3) in Brazil, the British red blood cell transfusion guidelines in the United Kingdom (6) are all examples of recommendations and guidelines aimed at improving blood transfusion safety. Additionally, especially since the 1990s, transfusion committees and hemovigilance programs began to be regulated and deployed, initially in France in 1993 and thereafter in England with the Serious Hazards of Transfusion (SHOT) initiative in 1996 (7) , which was extended to the Common Market with the institution of the European Hemovigilance Network. In Brazil, the National Hemovigilance scheme was implemented in 2002 with the objectives of collecting and processing information or unexpected adverse effects resulting from the transfusion of blood and also of preventing administrative errors (clerical errors such as typing, recording, conference mistakes, etc.). The latter, surprisingly, is more common than viral transmissions and often omitted by the services in Brazil and is not reported in the statistics (8). While the system of notification of transfusion reactions in the UK (SHOT) revealed that approximately 66.7% of transfusion reactions reported are related to errors in the identification of recipients (7) , a study conducted at the Department of Health of the State of New York determined that the risk management of wrong red blood cell (RBC) transfusions is one in every 14,000 transfusions performed and misclassification of ABO is 1 for every 38,000 transfusions (9). Moreover, data from Bulletin No. 5 (2012) of the national agency of Sanitary surveillance in Brazil, ANVISA, reported 5340 …