Transfus Apher Sci
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Clinical decision making in transfusion medicine has received greater attention in recent years driven by concern about the potential hazards, especially since the recognition that HIV can be transmitted by homologous blood transfusion. These concerns about the risks of homologous transfusion has precipitated interest in the appropriateness of many transfusions and in the decision making processes in transfusion medicine. There has been increasing expenditure on the blood supply side to address the real or perceived potential infectious hazards. ⋯ This imbalance is now being addressed with the development of evidence based clinical guidelines for individual blood components, transfusion monitoring systems and quality assurance programmes. In this review of the process of clinical decision making in transfusion medicine and the factors involved in the ensuring a patient receives a safe and effect transfusion are addressed. The responsibilities of the patient's clinical carers are emphasised.
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The evolution of cardiac surgery has been accompanied by a wide variety of techniques and equipment available for blood conservation. It has also given us data that allows identification of preoperative risk factors for transfusion needs in other surgical specialties. There is however great diversity of opinion as to how this technology should be applied. ⋯ It is the authors' observation that the success of an intra-operation blood management program is twofold, early identification of patients and a multi-team approach of Surgeon, Haematologist, Transfusion services, Anaesthetist and Perfusionist. This team approach offers far greater depth for management of intra-operative blood conservation and transfusion practice. Interventions must be patient specific and targeted toward the best possible patients outcome.