Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy.
Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.
Transfus Apher Sci. 2020 Aug;59(4):102779. doi: 10.1016/j.transci.2020.102779. Epub 2020 Apr 27.
In advanced health systems it is increasingly important to offer effective medical services that have high quality and safety standards. We present an overview of the direct hazards and the indirect hazards associated with blood transfusions. Our aim is to focus on the potential medico-legal impacts of these hazards in the context of clinical risk management, incorporating the accumulating evidence from Patient Blood Management programs. The direct or deterministic hazards of transfusion refer to scenarios where the mechanisms for post transfusion damage are clearly traceable to the blood transfused in a 1:1 cause and effect manner. The indirect hazards can be defined as probabilistic and are associated with transfusion through epidemiological studies. The implementation of Patient Blood Management programs demonstrates that the use of a blood transfusion is not always necessary or unavoidable but can be considered modifiable. Review of the literature confirms that transfusion should not be the default option to manage anemia or blood loss. Instead, accumulating evidence demonstrates that a patient-centred, proactive approach to managing a patient's own blood is the new standard of care. It thus follows, an adverse transfusion event, where the transfusion was avoidable through the application of patient blood management, may constitute a profile for medical professional medical negligence. In an effort to maximise patient safety, transfusion medicine practice culture needs to shift towards a patient blood management approach, with hospitals implementing it as an important tool to minimize the risks of allogeneic blood transfusion.
在先进的医疗体系中，提供高质量、安全标准的医疗服务变得愈发重要。我们概述了输血相关的直接危害和间接危害。我们旨在关注这些危害在临床风险管理背景下潜在的医学法律影响，同时整合患者血液管理项目中积累的证据。输血的直接或确定性危害是指输血后损伤的机制可以明确追溯到以 1:1 的因果关系输注的血液的情况。间接危害可以定义为概率性的，与通过流行病学研究进行的输血相关。患者血液管理项目的实施表明，输血并不总是必要或不可避免的，而是可以被认为是可改变的。文献回顾证实，输血不应该成为治疗贫血或失血的默认选择。相反，越来越多的证据表明，以患者为中心、主动管理患者自身血液的方法是新的护理标准。因此，如果通过应用患者血液管理可以避免输血，而发生了不良输血事件，则可能构成医疗专业人员医疗过失的特征。为了最大程度地提高患者安全性，输血医学实践文化需要向患者血液管理方法转变，医院将其作为减少异体输血风险的重要工具。
