title: Strategies to reduce blood transfusion: a Latin-American perspective.
abstract: OBJECTIVE
  Anemia has been demonstrated to be detrimental in several populations such as high-surgical-risk patients, critically ill elderly, and cardiac patients. Red blood cell transfusion is the most commonly prescribed therapy for anemia. Despite being life-saving, it carries a risk that ranges from mild complications to death. The aim of this review is to discuss the risks of anemia and blood transfusion, and to describe recent developments in the strategies to reduce allogeneic blood transfusion.
  
  
  RESULTS
  In the past decades, clinical studies comparing transfusion strategies in different populations were conducted. Despite the challenges imposed by the development of such studies, evidence-based medicine on transfusion medicine in critically ill patients is being created. Different results arising from these studies reflect population heterogeneity, specific circumstances, and difficulties in measuring the impact of anemia and transfusion in a clinical trial.
  
  
  CONCLUSIONS
  An adequate judgment of a clinical condition associated with proper application of the available literature is the cornerstone in the management of transfusion in critical care. Apart from this individualized strategy, the institution of a patient blood management program allows goal-directed approach through preoperative recognition of anemia, surgical efforts to minimize blood loss, and continuous assessment of the coagulation status.
authors.affiliation: Surgical Intensive Care Unit, Heart Institute, University of São Paulo, Av Dr Enéas de Carvalho Aguiar, São Paulo, Brazil.
authors.forename: Ludhmila Abrahão
authors.initials: LA
authors.lastname: Hajjar
authors.forename: Julia Tizue
authors.initials: JT
authors.lastname: Fukushima
authors.forename: Juliano Pinheiro de
authors.initials: JP
authors.lastname: Almeida
authors.forename: Eduardo Atsushi
authors.initials: EA
authors.lastname: Osawa
authors.forename: Filomena Regina Barbosa Gomes
authors.initials: FR
authors.lastname: Galas
mesh_terms: D000740:Anemia / Q000209:etiology; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion; D006801:Humans; D007843:Latin America; D016032:Randomized Controlled Trials as Topic; D065227:Transfusion Reaction