Red Cell Transfusion: a Practical Guide
Edited by M arion R eid and S andra J. N ance. Humana Press, Totowa, New Jersey, 1997. Pp. 230. $99.50. ISBN 0-896-03412-7.
Article first published online: 25 DEC 2001
British Journal of Haematology
Volume 102, Issue 3, page 878, August 1998
How to Cite
Napier (1998), Red Cell Transfusion: a Practical Guide. British Journal of Haematology, 102: 878. doi: 10.1046/j.1365-2141.1998.102003878.x
- Issue published online: 25 DEC 2001
- Article first published online: 25 DEC 2001
This multi-author book is ambitiously intended by its editors to become the standard review and reference source in transfusion medicine. Fourteen chapters compiled by 21 authors cover all stages from donor selection through transfusion service testing procedures to the clinical aspects of red cell transfusion.
The book opens with an overview of the entire process from donor couch to patient bedside, before chapter 2 starts in earnest with a very comprehensive coverage of immunological aspects of relevance to transfusion science. This chapter surprisingly opens with a detailed discussion of MHC immunology and takes 20 pages before either red cells or transfusion are mentioned. The chapter is nevertheless a useful and succinct and review of modern immunology and gives practical applications of immunology as applied to compatibility testing; these in essence follow the American Association of Blood Banks recommendations. Recommendations for the potentially error prone but crucially important identification of patients admitted in emergency are rather vague and could benefit from being more specific. In discussing emergency provision of red cells where unresolved crossmatching problems exist, the curiously unhelpful statement is made that ‘the director of the transfusion service must determine which units must be used’. What happens when that person is unavailable? Perhaps it might have been better to indicate what principles determine how such a decision is made. Surely that would be expected in a book whose authors aspirations are that it be an authoritative reference source. Page 41 lists very comprehensively a checklist for red cell compatibility testing. Do the authors really advocate confirming that ‘donor segment forward and reverse ABO groups agree’ and that hospitals check that ‘donor ABO test results match that stated on the donor pack label?’
Autoimmune disorders and transfusion, PCH, drug-induced haemolysis and serological problems of non-pathogenic autoantibodies are covered very comprehensively. The place for use of irradiated units is discussed in the chapter on transfusion of immunocompromised patients. No mention is made of the need for specific shortening of the shelf-life for red cells destined for neonatal use. An omission is the lack of any clinical description of the features of transfusion graft-versus-host disease which would be important in facilitating recognition of this important condition. A subsequent chapter on neonatal and paediatric transfusion is almost a minitextbook in itself, but at the expense of repeating topics such as GVHD and CMV and haemoglobinopathies covered elsewhere. Both former topics figure again in the chapter covering solid organ transplantation; this chapter also includes IgA-related transfusion problems, duplicating, but more comprehensively, coverage in the later transfusion complications chapter.
A 20-page chapter is devoted to haemopoietic stem cell transplantation; is this fitting in a volume claimed to be devoted to red cell transfusion? It appears before and is longer than one on the more clearly relevant red cell transfusion topic of massive transfusion which occupies only 6 pages. Even within this comparatively meagre coverage of a notoriously difficult and contentious topic, space is found to discuss post-transfusion purpura and transfusion-related immunosuppression. Are these really massive transfusion issues? The concepts of red cell transfusion triggers and the complex and unresolved issues of appropriate clinical guidelines for red cell use are well discussed and indeed many would regard a critical discussion of these issues to be the true raison d'etre of a book with this title. Autologous transfusion has a chapter of its own; throughout the entire book the term ‘autogenic’ is used in place of the universally understood term ‘autologous’. This chapter could have benefited from a more critical appraisal of the clinical and cost effectiveness of these frequently misused procedures. The Chronic Transfusion Support chapter revisits clinical topics covered elsewhere; the reader will find only a 14-line paragraph cursorily covering transfusion of patients with thalassaemia and may not realize that he or she should look elsewhere for a fuller discussion. The vexed question of optimizing transfusion benefits and minimizing iron toxicity, in particular the up-to-date position with regard to chelator therapy, seem to have been glossed over, when it might have been expected these would form major contributions in a volume with this title.
Who are the intended readers of this work? The title certainly suggests to this reviewer that these might primarily be clinicians with an interest in promoting more effective red cell transfusion therapy. For this the numerous pressing clinical questions surrounding better use of red cells and the management of transfusion problems could have been given more critical and generous coverage. The book suffers from what seems to be a somewhat arbitrary selection of chapter topics and space has been wasted by unnecessary repetition. Nevertheless much practically useful information is provided and browsing students will find a number of useful chapters which would justify library purchase.