Consensus on red cell transfusion

Critically ill patients are often short of blood

Perioperative blood and red cell transfusion in elective surgery varies, apparently without justification, among clinical units.1 Guidelines have not been agreed about when to give a transfusion and how much blood to give. Evidence has not been gathered to justify the heterogeneity of transfusion practice, which exposes recipients to numerous hazards, albeit a small risk per “donor exposure.”2

Previous attempts have been made to establish guidelines: in 1988 the US National Institutes of Health's consensus conference on perioperative transfusion proposed that a haemoglobin concentration of <70 g/l justified transfusion. The recommendations, however, were so hedged around with the need to consider patients' clinical problems individually that the suggested haemoglobin concentration was only a small component in the decision.3 This is entirely appropriate as the haemoglobin concentration or packed cell volume alone gives insufficient information on which to base a decision to give a transfusion.

These uncertainties explain the consensus conference at the Royal College of Physicians of Edinburgh last …