Do liberal blood transfusions cause more harm than good?

摘要

Guidelines and evidence from randomised controlled trials and meta-analyses increasingly support restrictive blood transfusion, but it is being implemented only slowly, explain Lawrence Tim Goodnough and Michael Murphy. They argue that electronic systems for clinical decision support could improve blood use. Blood transfusions have been identified as one of the most overused therapies both in the United States and the UK. In England the National Comparative Audit of Blood Transfusion programme has found inappropriate use over several years (table 1) and there have been various initiatives to improve use. Choosing Wisely, a US initiative that supports evidence based care to minimise the harms of overtreat-ment, has highlighted five recommendations for minimising blood use (box I).