The silent risks of blood transfusion.
OBJECTIVE
Clinical research has identified blood transfusion as an independent risk factor for immediate and long-term adverse outcomes, including an increased risk of death, myocardial infarction, stroke, renal failure, infection and malignancy. New findings have called into question the traditional assumptions clinicians utilize in evaluating the risks and benefits of blood transfusion. Appreciation of newly recognized risks is important for conserving scarce resources and optimizing patient outcomes.


RESULTS
Recent clinical outcomes research has examined the impact of blood transfusion on critically ill patients, trauma patients, patients undergoing cardiac surgery, patients experiencing acute coronary syndromes, oncology patients and others. These studies provide additional evidence of adverse outcomes associated with blood transfusion in a wide variety of clinical contexts.


CONCLUSIONS
The benefits of blood transfusion have never been conclusively demonstrated, but evidence of transfusion-related harm continues to accumulate. Given the transfusion triggers that currently predominate in clinical practice it appears that clinical outcomes could improve significantly with more widespread adoption of restrictive transfusion strategies.
Rawn
James
J
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. jrawn@partners.org
D000740:Anemia / Q000628:therapy; D001793:Blood Preservation; D001803:Blood Transfusion / Q000401:mortality; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D004356:Drug Storage / Q000592:standards; D017408:Guidelines as Topic; D006331:Heart Diseases / Q000628:therapy; D006801:Humans; D012307:Risk Factors; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000628:therapy