The transfusion debate

Cutting back on blood transfusions for the critically ill can actually improve some patients' chances of survival, according to a study that may have a far-reaching impact on the treatment of the critically ill. After studying over 830 critically ill and anaemic patients in hospitals across Canada, Paul C Hebert and his team from the University of Ottawa question the common practice of giving critically ill patients red blood cells (RBCs) when they become mildly anaemic. They suggest that waiting until anaemia becomes severe can save both money and lives, and that younger and less critically ill patients are more likely to die if they get more transfusions. Though the reason for this is not known, studies have suggested that RBC-transfusions may suppress the immune system and cause circulatory problems in the capillaries. However, the findings do not apply to patients who are bleeding or suffering from heart attacks, cardiovascular disease or emphysema ( New England Journal of Medicine , Vol 340, No 8).