Szczepiorkowski Zbigniew M, Dunbar Nancy M
Departments of 1Pathology and.
Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. doi: 10.1182/asheducation-2013.1.638.
Transfusion of blood and blood components has been a routine practice for more than half a century. The rationale supporting this practice is that replacement of blood loss should be beneficial for the patient. This assumption has constituted the underpinning of transfusion medicine for many decades. Only over the past 20 years, we have seen a more concerted effort to answer very basic questions regarding the value of transfusion therapy. An assessment of the value of transfusion based on well-designed and appropriately powered randomized, controlled trials is the first step in optimizing transfusion practices. Systematic reviews provide the second step by building the knowledge base necessary to assess the impact of transfusion practice on patient outcomes. The third step is the development of clinical practice guidelines, and this occurs when systematic reviews are interpreted by individuals with expertise in transfusion medicine. Such guidelines are typically supported by professional organizations and/or health authorities. Implementation of clinical practice guidelines can be challenging, especially in an area as heterogeneous as transfusion medicine. However, clinical practice guidelines are necessary for the practice of evidence-based medicine, which optimizes patient care and improves patient outcomes. This review focuses on clinical practice guidelines for transfusion of three blood components: RBCs, platelets and plasma. In addition, we provide the approach used to implement clinical practice guidelines at our own institution.
输血及血液成分输注在半个多世纪以来一直是常规操作。支持这一操作的基本原理是，补充失血应对患者有益。几十年来，这一假设一直是输血医学的基础。仅在过去20年里，我们才看到人们更加齐心协力地去回答有关输血治疗价值的一些非常基本的问题。基于精心设计且样本量充足的随机对照试验对输血价值进行评估，是优化输血操作的第一步。系统评价通过构建评估输血操作对患者结局影响所需的知识库提供了第二步。第三步是制定临床实践指南，这发生在输血医学专家对系统评价进行解读时。此类指南通常得到专业组织和/或卫生当局的支持。实施临床实践指南可能具有挑战性，尤其是在像输血医学这样异质性很强的领域。然而，临床实践指南对于循证医学实践来说是必要的，循证医学可优化患者护理并改善患者结局。本综述重点关注红细胞、血小板和血浆这三种血液成分输注的临床实践指南。此外，我们还介绍了在我们自己的机构实施临床实践指南所采用的方法。
