I am a critical care nurse and have seen blood transfusions given in a controlled setting, as well as in what I like to call an "organized confusion" setting. Health care providers must abide by the strict guidelines for safe administration of blood products to minimize the occurrence of errors and adverse reactions ("A Review of Current Practice in Transfusion Therapy," May).

In the article, I noticed that one aspect was omitted-namely, the important step of inspection. In this step, the person administering the transfusion inspects the product itself for any characteristics that would make it unsafe for a transfusion. This inspection includes noting features such as uneven color (with one part being lighter or darker than the other part) or the presence of bubbles. These are examples of characteristics that should not be ignored, triggering the return of that unit of blood or blood product to the blood bank.

I really appreciated how the authors described the assessment cues related to delayed transfusion reaction; these cues are very often missed. With transfusion reactions sometimes occurring weeks after the transfusion, far too many practitioners fail to make the all-too-important connection.

Kassim Nesbitt, RN, CCRN

Brooklyn, NY