In August 2017, Canadian Blood Services changed its platelet product testing procedure to improve the detection of bacterial contamination. This change enhanced the safety of Canadian Blood Services platelet products and provided the opportunity to improve inventory management by extending the platelet shelf life from five to seven days.
Transfusion-related acute lung injury (TRALI) is a rare but serious syndrome characterized by sudden acute respiratory distress following transfusion. It is defined as new, acute lung injury (ALI) during or within six hours after blood product administration in the absence of temporally-associated risk factors for ALI.
Current recommendations of the NAC indicate that the provision of CMV-seronegative and leukoreduced blood products is potentially required only in the setting of intrauterine transfusion. In October 2017, Canadian Blood Services will stop the testing donor blood for anti-CMV antibodies except for a small inventory of blood components tested for the sole purpose of intrauterine transfusion.
The approach to transfusion in emergent situations varies dramatically depending on the clinical scenario. The primary guiding determinant is the clinician’s assessment of the rapidity of bleeding, the severity of hemorrhage or amount of blood lost, and the clinical stability of the patient. Using the severely injured trauma patient as a case study, this chapter will discuss the principles of massive hemorrhage and resuscitation, with the inclusion of special situations such as obstetrical hemorrhage, where data are available.