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Reviews of Educational Material  |   May 2012
Transfusion Therapy: Clinical Principles and Practice, Third Edition
Author Notes
  • University of California, San Francisco, San Francisco, California.
Article Information
Reviews of Educational Material / Coagulation and Transfusion
Reviews of Educational Material   |   May 2012
Transfusion Therapy: Clinical Principles and Practice, Third Edition
Anesthesiology 5 2012, Vol.116, 1167-1168. doi:10.1097/ALN.0b013e318248e5e4
Anesthesiology 5 2012, Vol.116, 1167-1168. doi:10.1097/ALN.0b013e318248e5e4
Edited by Paul D. Mintz, M.D. Bethesda, Maryland, American Association of Blood Banks Press, 2011. Pages: 937. Price: $220.00.
In the United States, a large percentage of the total blood transfusions, especially packed erythrocytes, are given during the perioperative period. Although there are numerous publications available regarding transfusion in the perioperative period, very few cover the broad spectrum of transfusion medicine in all patients. Dr. Mintz's text represents one of the few textbooks that covers the entire spectrum of transfusion medicine in a manner all clinicians can understand. The first edition of Transfusion Therapy: Clinical Principles and Practice  was published 12 yr ago with the stated purpose of providing clinicians sufficient knowledge to make intelligent blood component transfusion decisions. It also had the intent of providing clinicians advice for those patients in whom adverse events developed from blood transfusions. In this third edition, Dr. Mintz added chapters regarding trauma and massive transfusion, transfusion and critical care, reduction in pathogens in blood components and its implications, and alloimmunization to erythrocyte antigens. His goal was to fill a niche between large textbooks and the handbooks already published. Dr. Mintz also stated that the chapters were particularly well referenced and up to date because he was able to add information just weeks before the book's release, reflecting on the flexibility of the publishers.
The primary values to the perioperative physician (surgery, anesthesia, and trauma/critical care) are the well-written and succinct chapters regarding topics and clinical conditions of which we have limited knowledge or experience. Examples include chapter 4, Transfusion Therapy in Congenital Hemolytic Anemias, and chapter 7, Intrauterine, Neonatal, and Pediatric Transfusion Therapy.
In addition to Dr. Mintz, there are 49 authors for this edition. Whether these authors have direct expertise with perioperative, trauma, or critical care patients was not clear. Although difficult to ascertain from personal titles, apparently only one surgeon and no anesthesiologists or critical care physicians were authors of the chapters in this book.
Regrettably, the newer chapters with emphasis on transfusion therapy and trauma, massive transfusions, and critical care were superficial at best. In the past 3–4 yr, there have been numerous publications on the subject of massive blood transfusions and associated problems. For example, transfusion-related acute lung injury has been a major cause of morbidity and mortality from blood transfusions, yet this topic is dealt with in a cursory manner. Another issue is whether the sex of the blood donor is an important factor regarding the incidence of transfusion-related acute lung injury. There are other issues that deserve intense attention with regard to transfusion medicine. An example is the duration of the blood storage, which was lightly addressed in the text. Numerous publications question the efficacy of blood that has been stored for more than 14 days in certain clinical situations as well as the clinical advantages of using blood that is stored less than 14 days. This reviewer wishes the authors had synthesized all of the literature regarding this topic and provided a useful conclusion for the clinician.
Although this reviewer is not an expert in all of these areas, all the previously mentioned topics are examples of issues that deserve a complete analysis in a book as prestigious as this one and published by the American Association of Blood Banks. Despite these concerns, most of the chapters were actually written in a very thoughtful manner. I especially appreciated chapter 1, The Use of Blood Components before Invasive Bedside Procedures: A Critical Appraisal. This chapter reviewed the prophylactic use of blood components before invasive procedures, and carefully analyzed the assumptions that underlie the prophylactic administration of blood components, particularly with regard to specific bedside procedures such as central venous catheter insertion. Many relevant questions were posed, such as, “Does the fresh frozen plasma given before a procedure actually correct the abnormal coagulation test results?” There were several other chapters that achieved comparable scholarly levels when examining the subjects of the chapters.
From a technical point of view, many of the chapters have an inadequate number of figures and tables of which chapter 9, “Massive Transfusion and Transfusion Therapy in Trauma,” is an example. The addition of these would add visual interest and exemplify the information presented in the text. By the way, chapter 9 is the only chapter in which a surgeon is involved as a coauthor.
Overall, this book should be on the shelf of clinicians who care for patients who require blood transfusions. Despite the limited number of figures and tables in most chapters, it is easy to read and the concepts are well described in a concise manner. Most of these chapters are useful as quick reference in the operating room when an unusual issue arises regarding transfusion medicine. However, anesthesiologists who take care of patients who require transfusions need a far more scholarly analysis of transfusion issues in the perioperative period than presented in this book. This book also has considerable value in understanding how nonperioperative physicians and members of the hospital transfusion committee might think with regard to transfusion medicine. Understanding how the leaders in hospital transfusion committees think facilitates the overall management of transfusion medicine in the perioperative period.