Red blood cell transfusion in clinical practice

Summary Every year, about 75 million units of blood are collected worldwide. Red blood cell (RBC) transfusion is one of the few treatments that adequately restore tissue oxygenation when oxygen demand exceeds supply. Although the respiratory function of blood has been studied intensively, the trigge...

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Bibliographic Details
Published in:The Lancet (British edition) 2007-08, Vol.370 (9585), p.415-426
Main Authors: Klein, Harvey G, Dr, Spahn, Donat R, FRCA, Carson, Jeffrey L, MD
Format: Article
Language:English
Subjects:
Anemia - physiopathology
Anemia - therapy
Blood Grouping and Crossmatching - methods
Blood Specimen Collection - methods
Blood Specimen Collection - trends
Clinical Trials as Topic
Critical Care
Erythrocyte Transfusion - adverse effects
Erythrocyte Transfusion - statistics & numerical data
Erythrocytes - physiology
Humans
Internal Medicine
Oxygen - physiology
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Summary:Summary Every year, about 75 million units of blood are collected worldwide. Red blood cell (RBC) transfusion is one of the few treatments that adequately restore tissue oxygenation when oxygen demand exceeds supply. Although the respiratory function of blood has been studied intensively, the trigger for RBC transfusion remains controversial, and doctors rely primarily on clinical experience. Laboratory assays that indicate failing tissue oxygenation would be ideal to guide the need for transfusion, but none has proved easy, reproducible, and sensitive to regional tissue hypoxia. The clinical importance of the RBCs storage lesion (ie, the time-dependent metabolic, biochemical, and molecular changes that stored blood cells undergo) is poorly understood. RBCs can be filtered, washed, frozen, or irradiated for specific indications. Donor screening and testing have dramatically reduced infectious risks in the developed world, but infection remains a major hazard in developing countries, where 13 million units of blood are not tested for HIV or hepatitis viruses. Pathogen inactivation techniques are in clinical trials for RBCs, but none is available for use. Despite serious immunological and non-immunological complications, RBC transfusion holds a therapeutic index that exceeds that of many common medications.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(07)61197-0