Transfusion of packed red cells, a complex biologic product prepared from donated
blood, is unique in many respects when compared with other health interventions. Decisions
concerning the use of allogeneic red blood cell (RBC) transfusion in the treatment
of anemia and hemorrhage require a clear understanding of both the risks and benefits
of both the condition and its treatment. Although we have developed a much clearer
appreciation for the infectious and immunomodulatory risks of RBC transfusion over
the past 2 decades, the risks of anemia in many clinical settings and the benefits
of RBC transfusion are still inadequately characterized. We presume that the most
significant risk associated with anemia is the harm resulting from the decrease in
oxygen carrying capacity and plasma volume. The development of adverse health consequences
from anemia will, in part, depend on the capacity of the individual patient to compensate
for these changes. The benefits of transfusions are related to the capacity of RBCs
to correct these risks and possibly provide additional benefits such as increasing
oxygen delivery to supranormal ranges. Such a framework highlights the concept that
the tradeoffs of risks and benefits may not be equivalent. With the exception of patients
who refuse blood for religious reasons, it is impossible to clearly distinguish between
these competing risk and benefits outside a randomized clinical trial.
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© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
