[Blood requirements and transfusion practice evolution in surgery]

During the years 1990, the focus was on transfusion hazards and blood savings strategies. This resulted in a decrease in labile blood products consumption. For a few years, there is a reverse tendency, with a reincrease in blood products consumption. In the same time, the limit of saving strategies has been attained, by identifying the risk of lack of transfusion (or too low transfusion threshold). A so-called multimodal blood savings strategy must be set. Vigilance is mandatory concerning the blood savings strategies that are detailed by scientific societies consensus conferences. Those strategies include a good anticipation of blood requirement, improvement of surgical techniques, pre- and intra-operative autologous transfusion, blood clotting pharmacological improvements, and anesthesia techniques. Transfusion today is relatively safe. Blood requirements must be precisely assessed to avoid going from Charybdis to Scylla i.e. from over- to under-transfusion.