[Clinical aspects of packed red cell transfusion. Lessons learned from Jehovah's Witnesses?]

Area of Science:

• Clinical Physiology
• Transfusion Medicine
• Healthcare Economics

Context:

• Rising costs of blood products impact hospital budgets for major surgeries and cancer care.
• Current clinical practice often transfuses erythrocytes despite evidence suggesting lower hemoglobin levels suffice for tissue oxygenation.
• Jehovah's Witnesses, refusing transfusions, show comparable outcomes to transfused patients, providing valuable clinical data.

Purpose:

• To analyze the clinical outcomes of patients refusing blood transfusions.
• To question the liberal transfusion of erythrocytes based on physiological data and comparative outcomes.
• To advocate for a re-evaluation of transfusion triggers and practices in healthcare.

Summary:

• Physiological data indicate that a hemoglobin concentration (cHb) below 6.21 mmol/l (10 g/dl) meets tissue oxygen demand.
• Outcomes from Jehovah's Witnesses, who do not receive transfusions, mirror those of transfused patients.
• This suggests that current erythrocyte transfusion practices may be excessive.

Impact:

• Potential for significant cost reduction in healthcare by minimizing blood product usage.
• Reduced risks associated with homologous blood transfusions.
• Encourages evidence-based, patient-centered discussions regarding transfusion guidelines and requirements.