Chief medical officer warns that many blood transfusions are unnecessary
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《英国医生杂志》
Too many unnecessary blood transfusions are being done in England, said the Department of Health's chief medical officer, Professor Liam Donaldson, when he announced his annual report for 2003 on the state of public health.
Although his main message to the general public was the continuing importance of reducing the number of smokers and of following the lead of Ireland and the United States on smoke-free public places, the take home message for doctors was the need for more careful use of what he described as the "precious gift" of blood.
"Overall, blood is much safer in this country than in many others," he said.
But he was concerned that the pool of donors had fallen—by more than a fifth since 1999, when it was 2.1 million—and currently stands at 1.64 million.
"The gift of blood is too often squandered by its unnecessary and inappropriate use," said Professor Donaldson. "Undoubtedly too much blood is used at present," he said.
In his annual report, he questions the point at which it is sensible to do a transfusion in a patient. "Although the normal range of haemoglobin is from 13.5 g/dl to 17.5 g/dl for males and from 11.5 g/dl to 15.5g/dl for females, there is certainly no evidence that transfusion of someone with a haemoglobin level of 10 g/dl or above will improve their postoperative recovery. There is little evidence that transfusion of someone with a haemoglobin level of 8 g/dl is necessary."
Although the risk from transfusion was low, he highlighted the potential risk of error. There were 343 incidents of wrong blood being transfused in 2003, a 12% increase on 2002.
He was also deeply concerned that the results of an audit by the National Blood Transfusion Service and Royal College of Physicians, published in November 2003, showed that a tenth of all patients needing a blood transfusion were not wearing wristbands that would identify their blood group and that, even more worryingly, one in seven unconscious patients was not wearing a wristband.
Among several recommendations, he suggests that only consultants—not junior doctors—should be allowed to order blood or blood products for patients.(Lynn Eaton)
Although his main message to the general public was the continuing importance of reducing the number of smokers and of following the lead of Ireland and the United States on smoke-free public places, the take home message for doctors was the need for more careful use of what he described as the "precious gift" of blood.
"Overall, blood is much safer in this country than in many others," he said.
But he was concerned that the pool of donors had fallen—by more than a fifth since 1999, when it was 2.1 million—and currently stands at 1.64 million.
"The gift of blood is too often squandered by its unnecessary and inappropriate use," said Professor Donaldson. "Undoubtedly too much blood is used at present," he said.
In his annual report, he questions the point at which it is sensible to do a transfusion in a patient. "Although the normal range of haemoglobin is from 13.5 g/dl to 17.5 g/dl for males and from 11.5 g/dl to 15.5g/dl for females, there is certainly no evidence that transfusion of someone with a haemoglobin level of 10 g/dl or above will improve their postoperative recovery. There is little evidence that transfusion of someone with a haemoglobin level of 8 g/dl is necessary."
Although the risk from transfusion was low, he highlighted the potential risk of error. There were 343 incidents of wrong blood being transfused in 2003, a 12% increase on 2002.
He was also deeply concerned that the results of an audit by the National Blood Transfusion Service and Royal College of Physicians, published in November 2003, showed that a tenth of all patients needing a blood transfusion were not wearing wristbands that would identify their blood group and that, even more worryingly, one in seven unconscious patients was not wearing a wristband.
Among several recommendations, he suggests that only consultants—not junior doctors—should be allowed to order blood or blood products for patients.(Lynn Eaton)