Strategies for reducing the exposure to donor blood

Blood usage is reducing, but there remains wide variation between clinical teams There is potential for further reduction in blood use by avoidance of inappropriate transfusion and greater use of alternatives to donor blood Recent data from a small number of randomised controlled trials indicate that reduced use of blood does not impair clinical outcomes, but more high quality evidence is needed about blood transfusion practice The combination of algorithms for blood management and the adoption of restrictive transfusion thresholds is the best approach to blood conservation Blood usage is greater in medical than in surgical patients, but most efforts for blood conservation so far have been in surgery Specific methods for reducing blood usage in surgery include the identification and treatment of pre-operative anaemia, and the use of intra-operative cell salvage and drugs such as aprotinin in selected groups of surgical patients.