Can we safely restrict transfusion in trauma patients?
OBJECTIVE
Transfusion of red blood cells in the trauma patient can be lifesaving. The question is how much and when? It is important to weigh the risks and benefits of red blood cell transfusions, as well alternatives to transfusion as these products are not benign.


RESULTS
We explore the evidence, and provide the rationale for current and future red blood cell transfusion strategies within a framework of prehospital and hospital care of the trauma patient. We also describe how red blood cell transfusion trends are changing in trauma, discuss alternatives to red blood cell transfusion and present evidence from randomized controlled trials that support a lower transfusion trigger.


CONCLUSIONS
Optimal transfusion practice and use of alternatives in trauma is a rapidly expanding and important area of research. Strong clinical evidence derived by future randomized controlled trials in the area of transfusion triggers as well as transfusion alternatives is required to determine their roles in clinical practice.
McIntyre
Lauralyn A
LA
Department of Medicine, Division of Critical Care, Centre for Transfusion and Critical Care Research, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. Imcintyre@Ottawahospital.on.ca
Hebert
Paul C
PC
D001802:Blood Substitutes / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data* / Q000639:trends; D003422:Critical Care; D017707:Erythrocyte Transfusion / Q000639:trends; D004921:Erythropoietin / Q000627:therapeutic use; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D047589:Leukocyte Reduction Procedures; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology; D010101:Oxygen Consumption / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D014947:Wounds and Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*
D001802:Blood Substitutes; D006490:Hemostatics; D004921:Erythropoietin