BENEFITS AND RISKS OF BLOOD-TRANSFUSION IN SURGICAL PATIENTS

This article attempts to put into a risk-related perspective modern re d blood cell (RBC) transfusion therapy. When making the decision to tr ansfuse, RBCs or blood products, it is important to weigh the risks an d benefits of the proposed therapy. It is equally important to evaluat e the risk of not transfusing and the morbidity and mortality associat ed with that decision. After nearly a century of use, RBC transfusions continue to be associated with a variety of risks. Although the initi al risks of mismatch and infectious disease transmission are ever decr easing, new risk considerations, particularly immunosuppression, are b eing uncovered. Because of the nearly universal worldwide fear of tran sfusion-related transmission of infectious disease a more conservative transfusion policy has generally taken hold. Transfusion avoidance ph ilosophies and then increased use of autologous RBCs have become commo nplace. This article puts a decision-oriented slant on the risk and be nefit of transfusion therapy. The issues behind the inability to disce rn a defined benefit as well as a commentary on the newly perceived ri sks 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 complicat ion is minimized compared to the mortality outcome. For cancer and tra uma patients, if transfusion is immunosuppressive and therefore detrim ental, alternatives must be considered. The newest question is whether the act of transfusion, independent of the form, allogeneic or autolo gous, is of itself immunosuppressive.