Consensus on red cell transfusion

Perioperative blood and red cell transfusion in elective surgery varies, apparently without justification, among clinical units.1 Guidelines have not been agreed about when to give a transfusion and how much blood to give. Evidence has not been gathered to justify the heterogeneity of transfusion practice, which exposes recipients to numerous hazards, albeit a small risk per “donor exposure.”2 Previous attempts have been made to establish guidelines: in 1988 the US National Institutes of Health's consensus conference on perioperative transfusion proposed that a haemoglobin concentration of <70 g/l justified transfusion. The recommendations, however, were so hedged around with the need to consider patients' clinical problems individually that the suggested haemoglobin concentration was only a small component in the decision.3 This is entirely appropriate as the haemoglobin concentration or packed cell volume alone gives insufficient information on which to base a decision to give a transfusion. These uncertainties explain the consensus conference at the Royal College of Physicians of Edinburgh last …