A Manual for Blood Conservation

This is a wonderful manual on blood conservation. Period. If ever clinicians and all those wonderful professionals involved in healing had a little prayer for owning a comprehensive manual on blood conservation then this is the answer to their prayers. Wonderfully complete yet concise and pocket-sized makes this book not only useful but also convenient and easy on the eye and the mind.

From a wonderful peep into the era when blood transfusions were at best experimental and at worst fatal, the history of blood transfusions makes interesting reading. The section on transfusion transmitted infections attempts to be comprehensive but in my opinion, certainly falls short of expectations. Some sweeping generalisations could well have been avoided like, “risks are greater in developing countries but the cost of improvement needs to be considered in relation to availability of resources…” My fervent wish that some governments take notice. The section on national inventories does marvellously, though.

The practicalities and indications, and some tips for venupuncture are invaluable for the junior house officers and/or the phlebotomists routinely involved in and exposed to the hazards of this procedure. More emphasis, needs to be placed on “is transfusion really necessary?” to make it more convincing and to change the mindset of the junior who is more likely to prescribe a blood product on the wards.

Multiple strategies for blood conservation and avoiding transfusions are admirably covered in a simple and appealing style. Fortunately the evidence base for each are examined honestly to impress upon the reader the feasibility and the efficacy of doing so, like “Level one evidence of the efficacy of Intra-operative cell salvage (ICS) is sparse but convincing, especially in vascular, cardiac and orthopaedic surgery”. A pity though that the problems cited in establishing a cell-salvage service are less convincing.

Surgical and anaesthetic methods (shouldn’t this read as anaesthesia techniques?) does a routine roundup of the methods available and is complete but not comprehensive. This sections being of more direct and practical application, it would be justifiable to treat these chapters with more finesse in future editions. “Haemostasis for surgeons and anaesthetists”, could well have been incorporated into the section here.

“Transfusion triggers” makes fantastic reading and is practical, sensible and evidence-based. The algorithm used for deciding the need for blood products is succinct and easy to implement. More importantly a clearly defined end-point has been identified to prevent unnecessary further usage. The section dealing with chronic anaemia is particularly relevant since this a commonly neglected area in other publications.

“Sixty percent of red cell transfusions occur on the ward”, and more importantly are ordered by the most junior of clinical cadres, thus making this chapter indispensable. The guidelines formulated from Southern General Hospital attempts to promote best practice and are applicable to any inpatient facility world-wide. They merit being put us as a chart on every nursing station. Good pointers are offered on treatment of Jehovah’s witnesses and minors who may refuse transfusions.

Further to the formation of the Hospital Transfusion Committee (HTC), newer concepts of the Transfusion Practitioner (TP) and the Hospital Transfusion Teams (HTT) are explained though it is not yet clear about their multiple roles and hierarchy in the overall context. “Many HTT chairpersons and haematologists involved in transfusions despair because of the lack of communication between various departments within the hospital”. Now seriously, how many times have you witnessed this in the practical setting? I have not.

Much has been made of the regulatory EU directives and yet, “EU has no jurisdiction on how member States` health services are run or on clinical practice”. The various councils and their powers are outlined and is of likely interest only to health planners and administrators.

In summary, this is a useful, practical, no-nonsense manual on blood conservation and attempts to teach exactly what it says on the covers- “Conserve Blood”. I believe that this publication will prove to be an invaluable addition to the hospital and/or the departmental library and should be treated with respect.

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