Blood transfusion: challenges and limitations

SUMMARY Blood transfusions provide essential supportive therapy but are costly and not without risk. The transmission of human immunodeficiency virus and hepatitis C virus through the blood supply has led to public, political and legal scrutiny of the safety of blood. Increasing numbers of precautionary measures have been introduced which both increase the costs and reduce the available donor base. Errors frequently occur in the multistep process of giving the correct blood to the correct patient, leading to ABO-incompatible transfusions and indefensible patient morbidity and mortality. Against this background, there is a paucity of evidence upon which to base the clinical practice of blood transfusion, and established prescribing habits are not regularly reviewed as a result of published clinical trials. Consequently, there is considerable inappropriate use. The essential challenges are to educate both clinicians and patients to appreciate the limitations and risks of allogeneic transfusion and to support the use of more rational alternatives.