Blood transfusion is an essential part of patient care. When used correctly, it saves lives and improves health. However, blood transfusion carries a potential risk of acute or delayed complications and transfusiontransmitted infections and should be prescribed only to treat conditions associated with significant morbidity or mortality that cannot be prevented or managed effectively by other means. Blood is a scarce human resource and ensuring its safety and clinical effectiveness requires investment -both human and financial. The national blood transfusion service (BTS) is responsible for ensuring the provision of an adequate supply of safe blood for all patients requiring transfusion. The national health programme should develop policies and strategies to reduce the need for transfusion, minimize unnecessary transfusions and ensure the safe and appropriate use of blood and blood products. These strategies should include: Prevention, early diagnosis and effective treatment of conditions that could result in the need for transfusion Use of good surgical and anaesthetic techniques, pharmaceuticals and medical devices to reduce blood loss Availability and use of simple alternatives for volume replacement, including intravenous replacement fluids (crystalloids and colloids) Appropriate prescribing of blood and blood products in accordance with national guidelines Safe pre-transfusion procedures Safe administration of blood and blood products.#
The national blood programme and clinical users of blood and blood products should work together to implement these policies and strategies.

# The Clinical Use of Blood Prerequisites
Well organized, nationally coordinated blood transfusion service National blood policy and plan incorporating the clinical use of blood National committee on the clinical use of blood Quality system for the BTS, hospital blood banks and clinical departments Adequate resources

# National guidelines
Clinical and laboratory indications for the use of blood, blood products and alternatives to transfusion Information about available blood products and alternatives to transfusion Standard blood request form Guidance on the development of blood ordering schedule and standard operating procedures at hospital level

# Education and training

# AIDE-MEMOIRE for National Health Programmes

# Words of advice
Secure government commitment and support for the development and implementation of a policy to promote the safe, appropriate use of blood Ensure a safe and adequate supply of blood and blood products Ensure the availability and use of simple alternatives to transfusion Establish a national committee on the clinical use of blood Develop national guidelines on the clinical use of blood Involve professional bodies and patient associations in the establishment of systems to ensure the safe and appropriate use of blood Provide training for all clinicians, nurses, BTS/hospital blood bank staff and other personnel involved in the transfusion process Establish transfusion committees in each hospital in which transfusion takes place Establish a system to monitor and evaluate blood usage Establish a national haemovigilance system to monitor, report and investigate adverse events associated with transfusion
The national blood programme has the responsibility to ensure that blood and blood products provided for clinical use are safe, adequate to meet demand, clinically effective and produced consistently to appropriate standards.
While responsibility for the decision to transfuse ultimately rests with individual clinicians, consistently effective clinical transfusion practice cannot be achieved unless the following are in place:

# Hospital transfusion committees Hospital transfusion committees Hospital transfusion committees Hospital transfusion committees Hospital transfusion committees
A transfusion committee should be established in each hospital to implement the national policy and guidelines and monitor the use of blood and blood products at the local level. The committee should have authority within the hospital structure to determine hospital policy in relation to transfusion and resolve any identified problems. The safety, adequacy and reliability of the supply of blood, blood products and alternatives to transfusion The traceability of all blood and blood products, from blood collection to transfusion Compliance with the national guidelines on transfusion and the impact on prescribing practice Differences in blood usage within hospitals and between similar hospitals at regional, provincial and district level Haemovigilance -the monitoring, reporting and investigation of all adverse events related to transfusion.

# National clinical guidelines National clinical guidelines National clinical guidelines National clinical guidelines National clinical guidelines
Transfusion guidelines should represent a consensus by clinical specialists, the BTS, pharmacists and professional bodies on the most effective treatments for