What’s new in transfusion policies?

Excerpt

Since 1667, when the first blood transfusion was given in humans, many millions of patients have undergone this intervention. However, despite its widespread use, the decision to transfuse is still driven by simplistic and arbitrary triggers, such as the hemoglobin level rather than integrated clinical variables [1]. For many years, the threshold generally used to guide transfusion practice was a hemoglobin concentration of 10 g/dL and a hematocrit of 30 %, the so-called 10/30 rule, derived from John Lundy's clinical experience in the 1940s [2]. Transfused blood was considered a perfect substitute for blood loss and a powerful treatment for anemia, with all its adverse consequences [3]. Nevertheless, the risks related to blood transfusion were well recognized, including errors in cross-matching, risks of transmission of pathogens, transfusion-associated circulatory overload (TACO), storage-lesion consequences, transfusion-related acute lung injury (TRALI), and transfusion-related immunomodulation (TRIM), which may be associated with an increased incidence of infectious complications. …