SIMTI recommendations on the correct use of blood components and plasma derivatives

The transfusion of blood components and plasma derivatives is often a life-saving treatment, but can also have side effects of considerable importance: this is the reason for the worldwide attention given to the problem of transfusion safety, which should be understood not only as the absence or removal of agents responsible for transfusion-transmissible diseases, but also in the wider perspective of guaranteeing the availability of the necessary blood component or plasma derivative at the right time for a given individual.

It is, therefore, important to avoid using a resource, which in any case is limited, in situations in which it is not necessary, when it can only lead to risks, and to be able to have all the transfusion products required in situations in which such therapy is appropriate.

In Italy there is a legal obligation for the Transfusion Service to adopt a procedure aimed at verifying the appropriateness of transfusion therapy. This control of the appropriateness of transfusion therapy does, however, presume that there are standards of behaviour and that these standards are known and collectively accepted not only by staff of the Transfusion Service, but also by professionals in medical and surgical fields that make use of transfusion therapy.

The Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) recently undertook the task of proposing regulations for the behaviour, organisation and management of transfusion facilities, defining professional standards for Italy¹, as already done by other scientific societies in some other countries, such as the United Kingdom, France, the United States of America and Canada.

In the meanwhile, SIMTI asked its own working group to produce recommendations on the use of blood components and the main plasma derivatives based on a thorough review of the literature and similar, already published, documents. The task was completed, the results validated by the national organs of the scientific society and, at the end of 2008, a volume was published presenting the clinical recommendations on the transfusion of red blood cells, plasma and platelets, and on the use of albumin, immunoglobulins, antithrombin concentrates and prothrombin complex².

The primary aim of this work is to make a scientifically rigorous, updated document on transfusion matters available for all Italian transfusion services. The second aim, which is perhaps more demanding and of greater clinical relevance, is to stimulate debate on these matters between professionals in other medical and surgical fields and institutions, in order to produce, through a process of revision and updating of the initial text, a jointly agreed document that, therefore, constitutes true "guidelines" against which the appropriateness of transfusion therapy can really be evaluated.

The key players necessary to transform this document from “recommendations" into “guidelines" are the National Blood Centre and the scientific societies of other disciplines interested in transfusion therapy. The main setting into which the document could be introduced is that of the “Hospital Committees for the Good Use of Blood" which Italian legislation requires in each hospital and which are the natural arena for clinical discussion and debate on the correct use of transfusions.

We are also convinced that knowledge of and comparison with similar experiences in other countries and equivalent documents produced internationally are of great importance for drawing up our national document. For this reason, starting from the first issue of 2009, Blood Transfusion will publish the SIMTI recommendations, beginning with those on the transfusion of red blood cells³. We are hoping to stimulate interest and discussion and to be able to publish comments and appraisals in our Journal.