Book Review

Clinical Practice of Transfusion Medicine

N Engl J Med 1996; 335:528-529August 15, 1996

Article

Clinical Practice of Transfusion Medicine
Third edition. Edited by Lawrence D. Petz, Scott N. Swisher, Steven Kleinman, Richard K. Spence, and Ronald G. Strauss. 1115 pp. New York, Churchill Livingstone, 1996. $149.95. ISBN: 0-443-08981-7

The third edition of Clinical Practice of Transfusion Medicine is a valuable general reference work on the practical, clinical, and technical aspects of transfusion practices. Since the second edition in 1989 (edited by Lawrence D. Petz and Scott N. Swisher. New York: Churchill Livingstone), three editors have been added. They have expertise in surgery, pediatric transfusion medicine, and transfusion-transmitted infectious disease, and in this edition the treatment of these subjects has been expanded and reorganized.

The book begins with a historical review of transfusion medicine and an overview of past and present challenges in this evolving multidisciplinary field. Chapters devoted to biologic principles fulfill the editors' goal of presenting a general scientific background for clinical and laboratory practices. They focus on immunology, blood groups, compatibility testing, and HLA. The section on the practical and organizational aspects of blood collection and transfusion contains comprehensive chapters of particular interest to physicians and trainees in transfusion medicine. It includes such topics as outpatient programs of transfusion and autologous and directed donation, algorithms for auditing transfusion practices, and a discussion of medicolegal issues. There are particularly well written chapters on transfusion practices in the surgical setting, trauma, obstetrics and gynecology, the transplantation of solid organs and bone marrow, and transfusion therapy for medical patients with chronic and acquired hemolytic anemias. Thus, this book will interest not only specialists in transfusion medicine, but also surgeons, obstetricians, and hematologists who seek a good general reference work. A section of six chapters is devoted to neonatal and pediatric transfusion medicine. Other chapters or topics not typically found in textbooks of clinical laboratory transfusion medicine include gene therapy, adoptive immunotherapy, and the care of patients who are Jehovah's Witnesses.

Some outstanding aspects of the book are the impressive list of contributing authors, the comprehensive coverage of diverse topics, and the thorough, useful index. Overall, the individual chapters are extensively referenced and impart interesting historical perspectives. The chapter on platelet transfusion provides not only practical guidelines, but also an analysis of the clinical studies on which the clinical practices are based. The chapter entitled “General Overview of Transfusion Transmitted Infections” includes an excellent discussion of the methods used to assess the risks of transfusion-transmitted disease. The chapters on solid-organ transplantation and the compatibility testing of red cells are laudable for their charts of protocols and the case studies they contain. Other charts include pertinent information on coagulation-factor concentrates, preparations of intravenous immune globulin that are available in the United States, and a summary of blood components and derivatives. These all enhance the practical usefulness of the book.

Our criticisms are minor and primarily concern the book's organization. Two chapters in the section on the biologic principles of transfusion medicine might have been better placed elsewhere. The fourth chapter, dealing with transfusion-induced immunomodulation, would have been more appropriate in a later section on the potential adverse effects of transfusion, since this subject does not yet constitute a well-defined body of information with established clinical significance. The chapter discussing the transfusion trigger (the level of hemoglobin that calls for transfusion therapy) and red-cell transfusion overlaps with the chapters on transfusion therapy, where the information could easily have been incorporated. An expanded discussion of the coagulation cascade would have been appropriate in the section on biologic principles.

Considering the length of many chapters, introductory outlines of each could have greatly enhanced the reader's appreciation of the scope and key concepts. In contrast, several relatively short chapters do not provide sufficient information to qualify as specialty references. Most notably, only one brief chapter is devoted to therapeutic hemapheresis. The chapter on the transplantation of peripheral-blood stem cells could have been enhanced by a better discussion of technical issues. The emerging field of umbilical-cord–blood banking is mentioned only in passing in this chapter.

Overall, this book is a well-written enhancement of the previous edition and an excellent technical, theoretical, and clinical reference work.

Eleanor S. Pollak, M.D.
Leigh C. Jefferies, M.D.
University of Pennsylvania Health System, Philadelphia, PA 19104