Factors Affecting the Clinical Efficacy of Blood Transfusion
For the purposes of this paper clinical efficacy as it describes a therapeutic product or manoeuvre is meant very specifically to mean the ability of that product or manoeuvre to benefit in a clinically meaningful way the patient who receives or undergoes it. For example a red blood transfusion may be ordered by a surgeon to raise the patient’s postoperative haemoglobin level to a figure that the surgeon feel comfortable with, but the patient will probably interpret the action, quite reasonably, as intended to improve well being or to prolong or maintain life . The patient’s trust may be misplaced in this case, for several reasons. A raised haemoglobin level is not acceptable as an endpoint of relevance in discussing clinical efficacy until such time as studies equate it with real benefit in terms of morbidity and mortality, and refute extant evidence to the contrary [2,3]. Clinically meaningful endoptions are confined to endpoints that would be valued by the patient and include saving life, prolonging life, decreasing morbidity, discomfort or pain, and increasing well-being, without doing anything that will undermine these valued gains. This definition excludes efficacy measured by many endoptions that are commonly accepted in the literature; however, endoptions such as a raised platelet count, avoidance of alloimmunization, even prevention of haemorrhage cannot be assumed to be of overall clinical value unless they have been shown to improve clinically important endpoints such as morbidity and mortality.
KeywordsBlood Transfusion Clinical Efficacy Thrombotic Thrombocytopenic Purpura Platelet Transfusion Transfusion Practice
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