title: Revisiting transfusion safety and alternatives to transfusion.
abstract: Transfusion of blood products can be life saving when used appropriately. It carries however at the same time a potential for morbidity and mortality, depending on the patient, the product or the setting. Numerous strategies have been elaborated to minimize these risks, and in recent years, transfusion has no longer been regarded as essential for the management of a wide range of diseases. Uncomplicated surgeries in well-prepared patients can now be conducted without the use of transfusions. Questions about transfusion safety and shortage have led to extensive research on alternatives to blood transfusion, ranging from non-pharmacological to pharmacological solutions. Restrictive transfusion therapies, preoperative autologous blood donations, perioperative red cell salvage, acute normovolaemic haemodilution techniques or patient blood management are potential solutions where prothrombin complex or fibrinogen concentrates, synthetic anti-fibrinolytic agents, desmopressin, rFVIIa, or erythropoiesis stimulating agents may play a complementary pharmacologic role.
authors.affiliation: Lausanne University Hospital CHUV, Department of Anesthesiology, rue du Bugnon 21, 1011 Lausanne, Switzerland. Electronic address: patrick.schoettker@chuv.ch.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schoettker
authors.affiliation: Lausanne University Hospital CHUV, Department of Anesthesiology, rue du Bugnon 21, 1011 Lausanne, Switzerland.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Marcucci
authors.affiliation: Cardiocentro Ticino, Department of Cardiac Anesthesiology and Intensive Care, Via Tesserete 48, 6900 Lugano, Switzerland.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Casso
authors.affiliation: Lausanne University Hospital CHUV, Department of Anesthesiology, rue du Bugnon 21, 1011 Lausanne, Switzerland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Heim
mesh_terms: D006801:Humans; D061214:Patient Safety; D065227:Transfusion Reaction