Benefits and risks of blood transfusion in surgical patients

This article attempts to put into a risk-related perspective modern red blood cell (RBC) transfusion therapy. When making the decision to transfuse, RBCs or blood products, it is important to weigh the risks and benefits of the proposed therapy. It is equally important to evaluate the risk of not transfusing and the morbidity and mortality associated with that decision. After nearly a century of use, RBC transfusions continue to be associated with a variety of risks. Although the initial risks of mismatch and infectious disease transmission are ever decreasing, new risk considerations, particularly immunosuppression, are being uncovered. Because of the nearly universal worldwide fear of transfusion-related transmission of infectious disease a more conservative transfusion policy has generally taken hold. Transfusion avoidance philosophies and then increased use of autologous RBCs have become commonplace. This article puts a decision-oriented slant on the risk and benefit of transfusion therapy. The issues behind the inability to discern a defined benefit as well as a commentary on the newly perceived risks is provided. Overall, when increased oxygen delivery is required, the addition of RBCs has an apparent survival benefit in some specific patients. In these patients the risk of transfusion-related complication is minimized compared to the mortality outcome. For cancer and trauma patients, if transfusion is immunosuppressive and therefore detrimental, alternatives must be considered. The newest question is whether the act of transfusion, independent of the form, allogeneic or autologous, is of itself immunosuppressive.