Bloody Easy: A Guide to Transfusion Medicine
Authors: Jack Gillon
Journal: Journal of the Royal Society of Medicine (2004)

Things can, and do, change fast in transfusion medicine. The push-pull of emerging infections, technological innovation and the ever-increasing stringency of regulation have led to extraordinary upheavals in recent years. In the UK this is best exemplified by the response to vCJD, where the precautionary approach to the possibility of transmission by blood or blood products led to increasingly severe donor exclusion criteria, a ban on the use of British donor plasma for fractionated products and the mandatory filtration of cellular blood components to remove white blood cells. All this at enormous expense, and over a short period of time. Now that a case of probable transfusion transmission has been described, further measures are inevitable, and it is highly likely that a ban on donors who have themselves received a blood transfusion in the past will be enforced by the time this book review appears, costing the transfusion services something like 10% of donations annually.

It would be difficult, in the current climate, to write an article on, say, recent advances in transfusion medicine, without running the risk that it will be out of date by the time it appears in print. How much more difficult it must be, therefore, for anyone attempting to produce more substantial educational materials—a textbook, for instance. The editors of Bloody Easy would appear to have hit on the ideal solution. They have developed an internet-based modular learning programme, with an accompanying spiral bound handbook available separately or in pdf downloadable form as part of the package on the web. The programme is restricted to 10 modules, covering the basics of blood transfusion, the clinical use of blood components, adverse events arising from transfusion, alternatives to transfusion of allogeneic blood, the use of IVIg and albumin and the transfusion support of patients with sickle cell disease. The graphics on both the website and the handbook are beautifully designed, and the website has a variety of pop-up windows and boxes with additional information and self-assessment questions. There is also quite a searching before and after multiple choice self-assessment exercise.

In some ways the handbook is comparable to the Handbook of Transfusion Medicine published in the UK by the Stationery Office. Though each is clearly angled towards its target readership, with clear reference to national guidelines and policies, there are only minor differences in factual content. The UK version, however, is much more wordy and comprehensive; the Canadian handbook, though a very accessible overview of current practice, is very much at the level of a primer.

The web program offers the opportunity to expand and develop the materials in the handbook and, crucially, to make sure that the material is always up to date. It is too early to say whether the latter objective will be achieved, but I was disappointed that the authors make no clear declaration of intent in this respect. Even more disappointing, though, is the failure of the web to go significantly beyond the scope of the handbook. Here and there a window takes us further than the information in the handbook—but seldom much further—and it is very curious that quite important information sometimes appears in one format but not the other. For example, the need for ABO compatibility when transfusing fresh frozen plasma is clearly set out on the website but is not mentioned in the handbook; conversely, the handbook has a statement of the risk of sepsis from pooled random platelets which I have been unable to find on the web. Indeed, finding things in either format is not easy. The handbook has no index and the web program no search facility. While the handbook has a useful reference list, this does not appear on the web. This is a major omission, and I would have hoped that the web program would go even further and provide hypertext links to key references, as it does to a few useful websites such as the UK SHOT reports.

I think that, for the present, this should be seen as a work in progress. The overall approach holds great promise (not least for those struggling to provide transfusion medicine in developing countries), but for US $100 I would want to know that the material is going to be expanded to cover a wider range of subjects in greater depth, that all the possibilities of the internet are going to be utilized, and that the material will be revised regularly. And that the truly (bloody?) awful title is not going to be permanent.