[Packed red blood cells-Avoidable risks and complications]

Packed red blood cells (PRBC) are indispensable but high-risk therapeutic agents with a high quality of preparation but the safety of administration is compromised by avoidable errors. The physician's decision for a transfusion must consider both the inherent risk profile of the high-quality product and the safety of administration. Key problem areas in the clinical use of PRBCs include confusion of products and hemolytic transfusion reactions due to process or identification errors, undertransfusion resulting from logistical bottlenecks or misjudgement and overtransfusion due to the overreliance on hemoglobin concentrations as transfusion trigger and a lack of adherence to guidelines. The risk of PRBC overdosing, in particular, is currently underestimated. As a large proportion of adverse events are application-related and therefore potentially preventable, technical safeguards, digitalization, structured processes and consistent patient blood management are essential measures for increasing patient safety.