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EDITORIALS: Drew Provan Better blood transfusion BMJ 1999; 318: 1435-1436 [Full text]

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Blood transfusion

Mark Harper   (17 June 1999)

Blood transfusion 17 June 1999
Mark Harper Send response to journal: Re: Blood transfusion	Dear Sir It was with great interest that I read Dr Provan's article regarding blood transfusion (1). I think that of particular note was his highlighting the need for local guidelines. The rational and evidence based use of allogenic blood is surely the simplest and most cost- effective means of reducing patients' exposure to it, and of course the financial burden of transfusion. There seems to be little consensus on the haemoglobin level at which patients should be transfused, and there are clinicians who will routinely transfuse for a given operation (such as total hip replacement) rather than taking individual circumstances into account. Hebert at al in their recently published study(2) produced results the implications of which could have a significant bearing on policies for allogenic transfusion. They randomised 838 critically ill patients into two groups. The first (liberal transfusion) group received packed red blood cells to maintain a haemoglobin (Hb) level of 10-12 g/dl; the second (restrictive transfusion) group were transfused only when their Hb dropped below 7g/dl, aiming for a level of 7-9g/dl. They concluded that "A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients, with the possible exception of patients with myocardial infarction and unstable angina." Such tolerance of anaemia is greater than that often encountered in everyday practice. Although one needs to extrapolate from the critically ill patients in this study to other medical populations, if guidelines adopted a restricted transfusion strategy demand for allogenic blood could be significantly reduced. Yours faithfully Mark Harper Anaesthetic SpR Department of Anaesthesia Royal Free Hospital Pond St London NW3 2QG 1 Provan D. Better blood transfusion: We must use donated blood better and consider alternatives. BMJ 1999;318:1435-6. 2 Hebert PC, Wells G, Blajchman M, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E,and the Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999;340:409-17.