Blood Transfusion Therapy: Components, Indications, Complications and Controversies

The monumental advances in blood transfusion therapy during the first half of this century have resulted in relatively safe homologous blood transfusion and nobody would doubt that blood transfusion has been the greatest single advance in the therapy of haemorrhagic shock.The birth of blood transfusion was plagued with problems of red cell incompatabiIity, anticoagulation, preservation, sterility and pyrogenicity.The second World War and subsequently the Korean and Vietnam conflicts gave great impetus to blood transfusion research."Blood is a remarkable juice" (Mephistopheles to Faust-Goethe), but this is only true while it is circulating within the living organism.When it is considered that blood is a complex biological fluid, containing a variety of cells, plasma proteins, carbohydrates, Iipids and electrolytes, it is amazing that it can be removed from the living organism and stored in a refrigerator, and subsequently transfused.To emphasize the obvious, blood is a perishable commodity, despite modem methods of storage, its transfusion into desperately ill patients may be associated with numerous problems, frequently unrecognized by the clinician.Until recently, the main criterion for suitability of stored blood for clinical use was its 24 hour post transfusion survival.As long as blood was serologically compatible, demonstrated a 70% 24 hour post transfusion survival and produced a satisfactory haemoglobin rise few other factors were considered (MolIison 1972).• F.R.