Doctors have been advised to consider alternatives to blood transfusion for patients requiring surgery.
The recommendation comes in light of concerns about the transmission of variant Creutzfeldt-Jakob disease. It is contained in a new set of guidelines for doctors on blood transfusions announced yesterday by the Department of Health, and drawn up by the National Blood Users Group, an expert group chaired by Prof John Bonnar, emeritus professor of obstetrics and gynaecology in Trinity College Dublin.
The core recommendation in the "Guideline for Transfusion of Red Blood Cells in Surgical Patients" is that proven strategies which reduce exposure to blood transfusions should be widely available and applied where appropriate.
Welcoming their publication, the Minister for Health, Mr Martin, said the recommendations were timely "particularly in the light of the concerns about the possible risk to patients of infection with vCJD".
The risk of contracting vCJD from blood transfusions is unknown and there has been speculation the Irish Blood Transfusion Service may ban blood from people who have lived in the UK, where the prevalence of vCJD is much greater.
The group noted:
doctors prescribing blood components must ensure there are clear and cogent reasons that outweigh any potential risk of vCJD transmission;
the use of red blood cell transfusion in surgical patients must be based on a clear expectation of benefit, based on "the best available evidence".
Specific measures in the guidelines include the treatment of anaemia before a patient is sent for surgery. Anaesthetists and surgeons are also advised to stop medication which might contribute to bleeding during surgery. Doctors are also advised not to transfuse patients with high haemoglobin levels.
In the past, it was accepted practice to transfuse at least two units of blood once the transfusion decision was made. The new guidelines say a single unit transfusion is acceptable and appropriate. The use of techniques to minimise blood loss during surgery is also encouraged.
The guidelines suggest that "autologous blood transfusion" be considered. This process allows a patient to donate blood in the months before surgery. This is then stored, for transfusion back into the patient, should the need arise. Routine use of "pre-operative assessment clinics" would encourage autologous transfusion and other preventive measures, it is suggested.
"The Red Cell Guideline is the first in a series of evidence-based guidelines being prepared by the group to cover the main aspects of transfusion practice in Irish hospitals," Prof Bonnar said.
Guidelines on neonatal and paediatric transfusion, the use of platelets and plasma, the provision of information to patients and the use of blood products in the management of massive haemorrhage are among those that the group expects to issue during 2001.