Alternative Approaches to Prevention of Alloimmunisation: A Virtue of Reality?

The main objectives of risk management in blood transfusion comes very close to the objectives of haemovigilance, described by McClelland [1] as: ‘the overall goal of haemovigilance must be to make clinical care safer for a patient who has a condition that may require some form of transfusion therapy. An important subsidiary purpose is to demonstrate to the public, patients and professionals the safety of existing transfusion systems. This needs to be done in a way that presents the risks and benefits of transfusion in a sensible perspective to show that where there are problems, these are recognised, effectively tackled and not ignored or kept secret’. As a clinician I feel very comfortable with such a definition because it is in a direct line of clinical practice. If a patient comes with abdominal pain the complaint is placed in perspective by generating a differential diagnosis including the most important possible causes. Then different pieces of information are used like history, physical examination, clinical laboratory tests and radiographic studies to help us refine the probability of disease for each significant diagnostic prospect. Another way of practice is to exclude every thinkable cause of abdominal pain by using every laboratory test, every radiographic study and every endoscopy you can perform. This last, in my opinion rejectable form of zero risk, defensive medicine is comparable with the reasoning of some people concerning blood transfusion.