Red Blood Cell Transfusion Practices

Red blood cell (RBC) transfusion therapy is used in the clinical setting for a variety of indications, including patient resuscitation, augmentation of oxygen delivery, and to reverse or alleviate the symptoms of anemia [1–5]. Despite calls for a more conservative approach to blood transfusion as early as the late 1950s [6,7], the trend toward more cautious transfusion practices did not begin until the 1980s. Several factors were responsible: concern over transmission of viruses; new means of processing blood; blood shortages; and the use of alternatives to blood [1–3,8–17]. While the risk of contracting a transfusion-related viral infection (eg, HIV, hepatitis) is lower than ever [17], blood systems worldwide continue to advocate a conservative approach to transfusions. This article reviews recent RBC transfusion practice in North America, including use of guidelines, variations in practice, and the benefits and risks associated with RBC transfusion.