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Effective and safe blood transfusion began in the early to middle 20th century when preservative solutions were developed and blood group types were identified. Continued advances in transfusion medicine have improved our understanding of the benefits and risks of blood component replacement.1 Currently, available products are purified so that precise factor or component replacement is common practice. Although there have been significant advances in individual factor and component replacement, an effective hemoglobin substitute is not yet available for clinical use.2

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Transfusion in the ED typically is done for acute blood loss and circulatory shock. As medical care is moved to outpatient settings and hospitals become more crowded, emergency physicians may be responsible for transfusion therapy that was once relegated to inpatient settings. Although patients requiring transfusion are often admitted to the hospital, this is not always necessary. Because most serious transfusion reactions occur during the course of transfusion, it generally is safe to discharge a patient home from the ED once transfusion is complete, unless there is another reason for admission. Available blood products are provided using standardized preparations or “units” (Table 233-1).

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Table 233-1 Characteristics of Blood Products
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Because the consequences of transfusing the wrong units of a blood product to the wrong patient can be fatal, great care is taken to assure that the correct blood product is delivered to the correct patient. Two individuals are typically used to verify the identification of the patient and the blood before transfusion. Emerging electronic technology, such as bar coding, can be used along with verification by one individual as an alternative.3

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Packed Red Blood Cells

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