Is best transfusion practice alone best clinical practice?

Abstract

The review by Shander et al. in this issue of the journal highlights the progress made in transfusion medicine since the 1980s, including the tremendous decrease in the risk of transfusion-transmitted infections (TTIs) and the development of remarkably similar (and uniformly restrictive) transfusion guidelines by five major professional societies and the American Association of Blood Banks1. These guidelines aim at reducing the number of a patient's allogeneic donor exposures as much as possible, by administering transfusion only when proven (rather than postulated) benefit can be expected from the transfusion. Proven benefit, exemplified by a red-blood-cell (RBC) transfusion to a stable and non-bleeding patient triggered by a haemoglobin of 7 g/dL, is based on findings from randomised controlled trials (RCTs) using clinical endpoints2. (...)