Transfusion Medicine
Canadian Society for Transfusion Medicine
Last updated: April 2026
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Blood transfusion should not be given if other safer non-transfusion alternatives are available. For example, patients with iron deficiency without hemodynamic instability should be given iron therapy.
Sources:
Carson JL, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med. 2012 Jul 3;157(1):49-58. PMID: 22751760.
Retter A, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol. 2013 Feb;160(4):445-64. PMID: 23278459.
Szczepiorkowski ZM, et al. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. PMID: 24319244.
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Indications for red blood transfusion depend on clinical assessment and the cause of the anemia. In a stable, non-bleeding patient, often a single unit of blood is adequate to relieve patient symptoms or to raise the hemoglobin to an acceptable level. Transfusions are associated with increased morbidity and mortality in high-risk hospitalized inpatients. Transfusion decisions should be influenced by symptoms and hemoglobin concentration. Single unit red cell transfusions should be the standard for non-bleeding, hospitalized patients. Additional units should only be prescribed after re-assessment of the patient and their hemoglobin value.
Sources:
Bracey AW, et al. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion. 1999 Oct;39(10):1070-7. PMID: 10532600.
Carson JL, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD002042. PMID: 22513904.
Carson JL, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med. 2012 Jul 3;157(1):49-58. PMID: 22751760.
Hebert PC, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409-17. PMID: 9971864.
Marik PE, et al. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit. Care Med. Sep 2008;36(9):2667-2674. PMID: 18679112.
Retter A, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol. 2013 Feb;160(4):445-64. PMID: 23278459.
Szczepiorkowski ZM, et al. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. PMID: 24319244.
Villanueva C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013 Jan 3;368(1):11-21. PMID: 23281973.
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A mildly elevated INR is not predictive of an increased risk of bleeding. Furthermore, transfusion of plasma has not been demonstrated to significantly change the INR value when the INR was only minimally elevated (<1.8).
Sources:
Abdel-Wahab OI, et al. Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities. Transfusion. 2006 Aug;46(8):1279-85. PMID: 16934060.
Estcourt L, et al. Prophylactic platelet transfusion for prevention of bleeding in patients with haematological disorders after chemotherapy and stem cell transplantation. Cochrane Database Syst Rev. 2012 May 16;(5):CD004269. PMID: 22592695.
Szczepiorkowski ZM, et al. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. PMID: 24319244.
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A platelet count of 10 X 109/L or greater usually provides adequate hemostasis. Platelet transfusions are associated with adverse events and risks. Considerations in the decision to transfuse platelets include the cause of the thrombocytopenia, comorbid conditions, symptoms of bleeding, risk factors for bleeding, and the need to perform an invasive procedure.
Sources:
British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the use of platelet transfusions. Br J Haematol. 2003 Jul;122(1):10-23. PMID: 12823341.
Estcourt L, et al. Prophylactic platelet transfusion for prevention of bleeding in patients with haematological disorders after chemotherapy and stem cell transplantation. Cochrane Database Syst Rev. 2012 May 16;(5):CD004269. PMID: 22592695.
Slichter SJ, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med. 2010 Feb 18;362(7):600-13. PMID: 20164484.
Szczepiorkowski ZM, et al. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. PMID: 24319244.
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Patients requiring non-emergent reversal of warfarin can often be treated with vitamin K or by discontinuing the warfarin therapy. Prothrombin complex concentrates should only be used for patients with serious bleeding or for those who need urgent surgery. Plasma should only be used in this setting if prothrombin complex concentrates are not available or are contraindicated.
Sources:
Holbrook A, et al. Evidence-Based Management of Anticoagulant Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e152S-84S. PMID: 22315259.
Keeling D, et al. Guidelines on oral anticoagulation with warfarin – fourth edition. Br J Haematol. 2011 Aug;154(3):311-24. PMID: 21671894.
National Advisory Committee on Blood and Blood Products (NAC). Prothrombin Complex Concentrates [Internet]. 2014 May [cited 2017 May 5].
Scottish Intercollegiate Guidelines Network (SIGN). Sign 129: Antithrombotics: Indications and Management [Internet]. 2013 Jun [cited 2017 May 5].
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Immunoglobulin (gammaglobulin) replacement does not improve outcomes unless there is impairment of antigen-specific IgG antibody responses to vaccine immunizations or natural infections. Isolated decreases in immunoglobulins (isotypes or subclasses), alone, do not indicate a need for immunoglobulin replacement therapy. Exceptions include genetically defined/suspected disorders. Measurement of IgG subclasses is not routinely useful in determining the need for immunoglobulin therapy. Selective IgA deficiency is not an indication for administration of immunoglobulin.
Sources:
Bonilla FA, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015 Nov;136(5):1186-205.e1-78. PMID: 26371839.
Otani IM, et al. Practical guidance for the diagnosis and management of secondary hypogammaglobulinemia: A Work Group Report of the AAAAI Primary Immunodeficiency and Alterned Immune Response Committees. J Allergy Clin Immunol. 2022 May;149(5):1525-1560. PMID: 35176351.
Perez EE, et al. Update on the use of immunoglobulin in human disease: A review of the evidence. J Allergy Clin Immunol. 2017 Mar;139(3S):S1-S46. PMID: 28041678.
Rich R, et al. Clinical Immunology: Principles and Practice, 6th edition. Elsevier; 2022.
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Pre-operative transfusion testing is not necessary for the vast majority of surgical patients (e.g., appendectomy, cholecystectomy, hysterectomy and hernia repair) as those patients usually do not require transfusion. Ordering pre-transfusion testing for patients who will likely not require transfusion will lead to unnecessary blood drawn from a patient and unnecessary testing performed. It may also lead to unnecessary delay in the surgical procedure waiting for the results. To guide you whether pre-transfusion testing is required for a certain surgical procedure, your hospital may have a maximum surgical blood ordering schedule or specific testing guidelines based on current surgical practices.
Sources:
Guidelines for implementation of a maximum surgical blood order schedule. The British Committee for Standards in Haematology Blood Transfusion Task Force. Clin Lab Haematol. 1990;12(3):321-7. PMID: 2272160.
Government of Newfoundland and Labrador. Guidelines for Maximum Surgical Blood Ordering Schedule, version 1.0 [Internet]. 2012 Dec 28 [cited 2017 May 5].
Ontario Regional Blood Coordinating Network (ORBCoN). Maximum Surgical Blood Order Schedule (MSBOS): Development Tool, version 1 [Internet]. 2014 Dec 5 [cited 2017 May 5].
University of Michigan. Providing Blood Components for Perioperative Patients [Internet]. 2010 Jan 4 [cited 2017 May 5].
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Males and females without childbearing potential can receive O Rh-positive red cells. O-negative red cell units are in chronic short supply, in some part due to over utilization for patients who are not O-negative. To ensure O-negative red cells are available for patients who truly need them, their use should be restricted to: (1) patients who are O-Rh-negative; (2) patients with unknown blood group requiring emergent transfusion who are female and of child-bearing age. Type specific red cells should be administered as soon as possible in all emergency situations.
Sources:
British Committee for Standards in Haematology, et al. Guidelines on the management of massive blood loss. Br J Haematol. 2006 Dec;135(5):634-41. PMID: 17107347.
Medical Officer’s National Blood Transfusion Committee (UK). The appropriate use of group O RhD negative red cells. Manchester (UK): National Health Service; 2008.
United Blood Services. A New Standard of Transfusion Care: Appropriate use of O-negative red blood cells [Internet]. 2017 [Cited 2017 May 5].
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The demand for AB plasma has increased. Group AB individuals comprise only 3% of Canadian blood donors. Those donors who are group AB are universal donors for plasma, thus are the most in-demand type for plasma transfusion. Type-specific plasma should be issued as soon as possible in emergency situations to preserve the AB plasma inventory for those patients where the blood group is unknown.
Sources:
Canadian Blood Services. Donating Plasma, What You Need to Know About Donating Plasma [Internet]. 2015 [cite 2017 May 5].
Canadian Blood Services. The Facts About Whole Blood [Internet]. 2015 [cited 2017 May 5].
Petraszko T. Transfusion Related Acute Lung Injury (TRALI) [Internet]. 2017 Feb [Cited 2017 May 5].
Yazer M, et al. How we manage AB plasma inventory in the blood center and transfusion service. Transfusion. 2013 Aug;53(8):1627-33. PMID: 23614505.
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5% albumin should not be used routinely because there is no evidence that it improves patient important outcomes (e.g., mortality, renal failure) in most clinical situations and is associated with potential harms, including pulmonary edema and fluid overload, as highlighted in the recent ICTMG 2024 albumin guidelines. Its primary indications are as replacement fluid for patients undergoing therapeutic apheresis or in patients with large thermal injuries, consistent with the American Burn Association Clinical Practice Guidelines.
Sources:
Callum J, et al. Use of intravenous albumin: a guideline from the International Collaboration for Transfusion Medicine Guidelines. Chest. 2024 Aug;166(2):321-338. Epub 2024 Mar 4. PMID: 38447639.
Cartotto R, et al. American Burn Association clinical practice guidelines on burn shock resuscitation. J Burn Care Res. 2024 May;45(3):565–589. PMID: 38051821.
Connelly-Smith L, et al. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the writing committee of the American Society for Apheresis: the ninth special issue. J Clin Apher. 2023 Apr;38(2):77–278. PMID: 37017433.
Relke N, et al. Albumin. In A. Khandelwal & K. Brooks (Eds.), Clinical guide to transfusion (Chap. 3). Canadian Blood Services. [Internet]. 2025 [cited 2025].
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Hyperoncotic 25% albumin is indicated for patients with cirrhosis and transudative ascites undergoing large volume paracentesis (>5L) to reduce the risk of paracentesis-induced circulatory dysfunction. Guidelines for malignant ascites do not recommend albumin administration, as malignant ascites is an exudative process rather than the transudative ascites in patients with cirrhosis, therefore, albumin is not recommended in this setting.
Sources:
Callum J, et al. Use of intravenous albumin: a guideline from the International Collaboration for Transfusion Medicine Guidelines. Chest. 2024 Aug;166(2):321-338. Epub 2024 Mar 4. PMID: 38447639.
Matsusaki K, et al. Clinical practice guideline for the treatment of malignant ascites: section summary in Clinical Practice Guideline for peritoneal dissemination. Int J Clin Oncol. 2022 Jan;27(1):1-6. Epub 2021 Nov 20. PMID: 34800177.
Simonetti RG, et al. Plasma expanders for people with cirrhosis and large ascites treated with abdominal paracentesis. Cochrane Database Syst Rev. 2019;6(6):CD004039. PMID: 31251387.
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Blood transfusions can be life saving for individuals with sickle cell disease (SCD); however, patients with SCD are at an increased risk for serious transfusion reactions, especially delayed hemolytic transfusion reactions. Avoiding unnecessary transfusions is critical. Standard hemoglobin thresholds used in the general population (e.g. 70 g/L) do not apply to patients with SCD. Patients with SCD generally have lower baseline hemoglobin levels and may develop hyperviscosity complications from transfusion. The need for transfusion in SCD should be determined in concert with national guidelines; the decision should involve hemoglobinopathy or hematology providers and/or transfusion medicine physicians.
Sources:
The Canadian Hemoglobinopathy Association. Sickle Cell Disease Consensus statement. [Internet] 2025 [cited 2026].
Davis B, et al. Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion. Br J Haematol 2017;176(2):192-209. PMID: 27858994.
Raza S, et al. Red Cell Transfusion in General Medicine Patients at Teaching and Non-teaching Hospitals: A Retrospective Cohort Analysis. J Gen Intern Med. 2026 Jan;41(2):311-320. Epub 2025 Oct 28. PMID: 41152565.
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The Canadian Society for Transfusion Medicine (CSTM) compiled its Choosing Wisely Canada list of recommendations by putting out a call to its membership for suggested list items. Members were asked to provide suggestions, rationale and references. Once all suggestions for list items had been received and the deadline for submissions had passed, the CSTM board voted on the accumulated list and ranked the items according to our assessment of what was most important. We met by conference call to discuss the outcome of the voting and worked together to refine the wording and the order of the list items and to find additional references as required.
Sources:
Carson JL, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med. 2012 Jul 3;157(1):49-58. PMID: 22751760.
Retter A, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol. 2013 Feb;160(4):445-64. PMID: 23278459.
Szczepiorkowski ZM, et al. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. PMID: 24319244.
Bracey AW, et al. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion. 1999 Oct;39(10):1070-7. PMID: 10532600.
Carson JL, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD002042. PMID: 22513904.
Carson JL, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med. 2012 Jul 3;157(1):49-58. PMID: 22751760.
Hebert PC, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409-17. PMID: 9971864.
Marik PE, et al. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit. Care Med. Sep 2008;36(9):2667-2674. PMID: 18679112.
Retter A, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol. 2013 Feb;160(4):445-64. PMID: 23278459.
Szczepiorkowski ZM, et al. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. PMID: 24319244.
Villanueva C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013 Jan 3;368(1):11-21. PMID: 23281973.
Abdel-Wahab OI, et al. Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities. Transfusion. 2006 Aug;46(8):1279-85. PMID: 16934060.
Estcourt L, et al. Prophylactic platelet transfusion for prevention of bleeding in patients with haematological disorders after chemotherapy and stem cell transplantation. Cochrane Database Syst Rev. 2012 May 16;(5):CD004269. PMID: 22592695.
Szczepiorkowski ZM, et al. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. PMID: 24319244.
British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the use of platelet transfusions. Br J Haematol. 2003 Jul;122(1):10-23. PMID: 12823341.
Estcourt L, et al. Prophylactic platelet transfusion for prevention of bleeding in patients with haematological disorders after chemotherapy and stem cell transplantation. Cochrane Database Syst Rev. 2012 May 16;(5):CD004269. PMID: 22592695.
Slichter SJ, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med. 2010 Feb 18;362(7):600-13. PMID: 20164484.
Szczepiorkowski ZM, et al. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638-44. PMID: 24319244.
Holbrook A, et al. Evidence-Based Management of Anticoagulant Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e152S-84S. PMID: 22315259.
Keeling D, et al. Guidelines on oral anticoagulation with warfarin – fourth edition. Br J Haematol. 2011 Aug;154(3):311-24. PMID: 21671894.
National Advisory Committee on Blood and Blood Products (NAC). Prothrombin Complex Concentrates [Internet]. 2014 May [cited 2017 May 5].
Scottish Intercollegiate Guidelines Network (SIGN). Sign 129: Antithrombotics: Indications and Management [Internet]. 2013 Jun [cited 2017 May 5].
Bonilla FA, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015 Nov;136(5):1186-205.e1-78. PMID: 26371839.
Otani IM, et al. Practical guidance for the diagnosis and management of secondary hypogammaglobulinemia: A Work Group Report of the AAAAI Primary Immunodeficiency and Alterned Immune Response Committees. J Allergy Clin Immunol. 2022 May;149(5):1525-1560. PMID: 35176351.
Perez EE, et al. Update on the use of immunoglobulin in human disease: A review of the evidence. J Allergy Clin Immunol. 2017 Mar;139(3S):S1-S46. PMID: 28041678.
Rich R, et al. Clinical Immunology: Principles and Practice, 6th edition. Elsevier; 2022.
Guidelines for implementation of a maximum surgical blood order schedule. The British Committee for Standards in Haematology Blood Transfusion Task Force. Clin Lab Haematol. 1990;12(3):321-7. PMID: 2272160.
Government of Newfoundland and Labrador. Guidelines for Maximum Surgical Blood Ordering Schedule, version 1.0 [Internet]. 2012 Dec 28 [cited 2017 May 5].
Ontario Regional Blood Coordinating Network (ORBCoN). Maximum Surgical Blood Order Schedule (MSBOS): Development Tool, version 1 [Internet]. 2014 Dec 5 [cited 2017 May 5].
University of Michigan. Providing Blood Components for Perioperative Patients [Internet]. 2010 Jan 4 [cited 2017 May 5].
British Committee for Standards in Haematology, et al. Guidelines on the management of massive blood loss. Br J Haematol. 2006 Dec;135(5):634-41. PMID: 17107347.
Medical Officer’s National Blood Transfusion Committee (UK). The appropriate use of group O RhD negative red cells. Manchester (UK): National Health Service; 2008.
United Blood Services. A New Standard of Transfusion Care: Appropriate use of O-negative red blood cells [Internet]. 2017 [Cited 2017 May 5].
Canadian Blood Services. Donating Plasma, What You Need to Know About Donating Plasma [Internet]. 2015 [cite 2017 May 5].
Canadian Blood Services. The Facts About Whole Blood [Internet]. 2015 [cited 2017 May 5].
Petraszko T. Transfusion Related Acute Lung Injury (TRALI) [Internet]. 2017 Feb [Cited 2017 May 5].
Yazer M, et al. How we manage AB plasma inventory in the blood center and transfusion service. Transfusion. 2013 Aug;53(8):1627-33. PMID: 23614505.
Callum J, et al. Use of intravenous albumin: a guideline from the International Collaboration for Transfusion Medicine Guidelines. Chest. 2024 Aug;166(2):321-338. Epub 2024 Mar 4. PMID: 38447639.
Cartotto R, et al. American Burn Association clinical practice guidelines on burn shock resuscitation. J Burn Care Res. 2024 May;45(3):565–589. PMID: 38051821.
Connelly-Smith L, et al. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the writing committee of the American Society for Apheresis: the ninth special issue. J Clin Apher. 2023 Apr;38(2):77–278. PMID: 37017433.
Relke N, et al. Albumin. In A. Khandelwal & K. Brooks (Eds.), Clinical guide to transfusion (Chap. 3). Canadian Blood Services. [Internet]. 2025 [cited 2025].
Callum J, et al. Use of intravenous albumin: a guideline from the International Collaboration for Transfusion Medicine Guidelines. Chest. 2024 Aug;166(2):321-338. Epub 2024 Mar 4. PMID: 38447639.
Matsusaki K, et al. Clinical practice guideline for the treatment of malignant ascites: section summary in Clinical Practice Guideline for peritoneal dissemination. Int J Clin Oncol. 2022 Jan;27(1):1-6. Epub 2021 Nov 20. PMID: 34800177.
Simonetti RG, et al. Plasma expanders for people with cirrhosis and large ascites treated with abdominal paracentesis. Cochrane Database Syst Rev. 2019;6(6):CD004039. PMID: 31251387.
The Canadian Hemoglobinopathy Association. Sickle Cell Disease Consensus statement. [Internet] 2025 [cited 2026].
Davis B, et al. Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion. Br J Haematol 2017;176(2):192-209. PMID: 27858994.
Raza S, et al. Red Cell Transfusion in General Medicine Patients at Teaching and Non-teaching Hospitals: A Retrospective Cohort Analysis. J Gen Intern Med. 2026 Jan;41(2):311-320. Epub 2025 Oct 28. PMID: 41152565.
About Choosing Wisely Canada
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices.
Web: choosingwiselycanada.org
Email: info@choosingwiselycanada.org
Twitter: @ChooseWiselyCA
Facebook: /ChoosingWiselyCanada
Canadian Obstetrical and Pediatric Transfusion Network
Canadian Society for Transfusion Medicine
Last updated: July 2023
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The likelihood of requirement for transfusion at the time of delivery is low. In a patient with a prenatal record confirming maternal ABO, Rh and a negative antibody screen provision of emergency uncrossmatched units is relatively safe when required on rare occasions. Routine pre delivery group and screen is not cost effective given the very low risk of transfusion with either vaginal delivery or routine Caesarean section. In the rare occasion that patients require a blood transfusion, O negative un-crossmatched blood or a stat crossmatch could be done pre-transfusion.
Sources:
Stock O, et al. Why group & save? Blood transfusion at low-risk elective caesarean section. Aust N Z J Obstet Gynaecol. 2014 Jun;54(3):279-82. PMID : 24576105.
White J, et al. Guideline for blood grouping and red cell antibody testing in pregnancy. Transfusion Medicine. Aug 2016;26(4):246-63. PMID: 27074872.
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Serologically weak reactions with Anti D antisera (≤ 2+) should be investigated with RHD genotyping. Pregnant mothers with weak or variable RhD typing and with pending genotyping results should be treated as RhD negative and should receive RhIg. Patients with genotyping confirming weak D type 1, 2 or 3 should be treated as RhD positive. Patients with other weak and variant RHD genotypes should be treated as RhD negative.
Sources:
Flegel WA, et al. It’s time to phase out “serologic weak D phenotype” and resolve D types with RHD genotyping including weak D type 4. Transfusion. 2020 Apr;60;855–59. PMID: 32163599.
Sandler SG, et al. It’s time to phase in RHD genotyping for patients with a serologic weak D phenotype. Transfusion. 2015 Mar; 55(3): 680–89. PMID: 25438646.
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Testing of a paternal sample and finding a negative antigen status (when paternity is assured) and/or non-invasive prenatal determination of the fetal genotype from maternal plasma with prediction of a negative antigen status confirm that the fetus is not at risk for hemolytic disease of the fetus and newborn and that ongoing pregnancy monitoring is unnecessary.
Sources:
de Haas M, et al. Haemolytic Disease of the fetus and newborn. Vox Sang. 2015 Aug;109(2):99–113. PMID: 25899660.
Scheffer PG, et al. Noninvasive fetal blood group genotyping of rhesus D, c, E and of K in alloimmunised pregnant women: evaluation of a 7-year clinical experience. BJOG. 2011 Oct;118(11):1340–8. PMID: 21668766.
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The DAT is not a screening test for hyperbilirubinemia or hemolytic disease. Routine assessment of the DAT may reveal cases of ABO incompatibility which are clinically insignificant; conversely the DAT may fail to identify significant hemolysis due to non immune causes. The DAT should be performed only when anemia or hyperbilirubinemia is suspected or when maternal alloantibodies are present.
Sources:
Aydin M, et al. Is the Antiglobulin Test a Good Marker for Predicting the Development of Hemolytic Disease of the Newborn in ABO Incompatibility? Pediatr Neonatol. 2016 Oct; 57(5),449. PMID: 27211278.
Dinish D. Review of positive direct antiglobulin tests found on cord blood sampling. J. Paediatr. Child Health. 2005 Oct; 41(9-10), 504-7. PMID: 16150068.
Judd WJ. Practice guidelines for prenatal and perinatal immunohematology, revisited. Transfusion. 2001 Nov;41(11):1445-52. PMID: 11724993.
Le Doare K, et al. Fifteen minute consultation: managing neonatal and childhood herpes encephalitis. Arch Dis Child Educ Pract Ed. 2015 Apr;100(2):58-63. PMID: 25112286.
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The Canadian Obstetrics and Pediatric Transfusion Network (COPTN) compiled its Choosing Wisely Canada list of recommendations by putting out a call to its membership for suggested list items. The chairs of COPTN compiled these suggestions and developed the rationale and references. These statements and rationale were presented virtually to the COPTN committee who ranked the suggestions according to their importance and refined the wording and the order of the item lists.
Sources:
Stock O, et al. Why group & save? Blood transfusion at low-risk elective caesarean section. Aust N Z J Obstet Gynaecol. 2014 Jun;54(3):279-82. PMID : 24576105.
White J, et al. Guideline for blood grouping and red cell antibody testing in pregnancy. Transfusion Medicine. Aug 2016;26(4):246-63. PMID: 27074872.
Flegel WA, et al. It’s time to phase out “serologic weak D phenotype” and resolve D types with RHD genotyping including weak D type 4. Transfusion. 2020 Apr;60;855–59. PMID: 32163599.
Sandler SG, et al. It’s time to phase in RHD genotyping for patients with a serologic weak D phenotype. Transfusion. 2015 Mar; 55(3): 680–89. PMID: 25438646.
de Haas M, et al. Haemolytic Disease of the fetus and newborn. Vox Sang. 2015 Aug;109(2):99–113. PMID: 25899660.
Scheffer PG, et al. Noninvasive fetal blood group genotyping of rhesus D, c, E and of K in alloimmunised pregnant women: evaluation of a 7-year clinical experience. BJOG. 2011 Oct;118(11):1340–8. PMID: 21668766.
Aydin M, et al. Is the Antiglobulin Test a Good Marker for Predicting the Development of Hemolytic Disease of the Newborn in ABO Incompatibility? Pediatr Neonatol. 2016 Oct; 57(5),449. PMID: 27211278.
Dinish D. Review of positive direct antiglobulin tests found on cord blood sampling. J. Paediatr. Child Health. 2005 Oct; 41(9-10), 504-7. PMID: 16150068.
Judd WJ. Practice guidelines for prenatal and perinatal immunohematology, revisited. Transfusion. 2001 Nov;41(11):1445-52. PMID: 11724993.
Le Doare K, et al. Fifteen minute consultation: managing neonatal and childhood herpes encephalitis. Arch Dis Child Educ Pract Ed. 2015 Apr;100(2):58-63. PMID: 25112286.
About Choosing Wisely Canada
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices.
Web: choosingwiselycanada.org
Email: info@choosingwiselycanada.org
Twitter: @ChooseWiselyCA
Facebook: /ChoosingWiselyCanada
Using Blood Wisely
A national campaign that aims to reduce unnecessary red blood cell transfusions in hospital settings.