Opinion: Transfusion Education for Physicians

Although there are resources allocated for nursing transfusion proficiencies, the training for physicians and medical students may not be as developed.

In medical school in the United States, I had one hour dedicated to transfusion medicine and it did not discuss the actual proficiencies necessary to select and physically transfuse patients.  In my clinical rotations, especially surgery, I was given “cookbook formulae” on what to order for different procedures—without any explanation.

I had considerable training in transfusion medicine during my pathology residency, and I took it seriously.  Many/most pathology residents are not interested in the topic and use the rotation for vacations and other business.  They learn what is necessary to pass the pathology board examinations and do not intend to practice this at all.  Actually, I sense that many practicing pathologists are afraid of blood bank and minimize their activities there.

What about the non-pathology residency training?  In the Middle East, some centers rotate the hematology, surgical, and obstetrics-gynecology residents through the blood bank.  In other posts, I have discussed some training plans I have used for each group.

Sadly, however, most practicing physicians do not well understand how to select and order blood components or administer components.  I try to tell them that they should at least know if the blood components being used for their family members are correct.

In a previous position, there were mandatory training programs for physicians including infection control, fire,  and disaster training.  There was even a program on handwashing!  Yet, there was no required training for transfusion practices.  I had offered to make such a training program but there was little interest.

Minimally, such a proficiency program should be offered to all physicians who might order a transfusion.  It should include:

  • Indications for transfusion of each component type including the institution’s transfusion triggers
  • Indications for modified components, e.g. irradiated, aliquoted, etc.
  • How to order blood components—manually and in the institution’s computer system
  • How to administer blood components, including the maximum transfusion times (e.g. four hours for RBC components), use of filters, etc.
  • Recognition and treatment of transfusion reactions and other adverse effects

In my career, I received blood component orders with many errors.  In the pre-computer, paper era, the blood bank staff automatically corrected these under the direction of the blood bank medical director.  Nowadays, with computer systems, it may not be possible for the blood bank staff to “autocorrect” the orders.

In my Middle Eastern practice, we could still correct the orders—even after adopting a blood bank computer system.  That will be the subject of a future post.