Appropriateness and safety of blood transfusion

We are spending a lot on safety and little on effectiveness

For a decade, huge sums have been spent on reducing infectious risks of blood transfusion in the United Kingdom. Since it seems paradoxical to finesse the safety of a medication when it is often used unnecessarily, we need to invest in understanding when transfusion will be effective.1 Transfusion can avert death from haemorrhage, prevent bleeding when the marrow is suppressed, or raise the haemoglobin count rapidly when it is dangerously low. However, well designed clinical trials seem to have disproved some widely accepted indications for transfusion.

About 2.5 million units are supplied annually in the United Kingdom, of which 40-50% are used in elective and emergency surgery2 and 5% in intensive care. A single large randomised trial showed that critically ill patients did as well or better with less transfusion.3 A recent small trial found that two units of red cells had no effect on oxygenation in patients in intensive care units whose haemoglobin concentration was below 80 g/l.4 In neonates, a liberal transfusion regime was …