Perioperative blood transfusion: A brief review of pros and cons

In the treatment of anemia, potential benefits should be weighed against risks, costs and limited availability of blood products. Alternatives to blood transfusion, such as preoperative blood donation and pharmacological interventions (e.g., erythropoietin, intravenous iron supplementation, etc.) ought to be considered before deciding on blood transfusion for the correction of anemia. In normovolemic patients with adequate cardiopulmonary function, acute anemia is usually tolerated well. Therefore, acute normovolemic hemodilution, eventually combined with preoperative autologous blood donation, and/or intraoperative red cell salvage, may reduce the requirements of perioperative transfusion of homologous blood. A universal threshold of hemoglobin level for blood transfusion has not been established. Patients with co-existing diseases (especially cardiopulmonary pathologies) may potentially benefit from a higher hemoglobin level. However, there is no clear-cut data-based evidence to support the necessity of a higher hemoglobin level transfusion threshold in these patients. Transfusion of blood products is associated with risks, some of them life threatening; therefore, the indication for transfusion should be weighed individually, based on a risk-benefit ratio consideration. Nevertheless, in clinical practice, surgeons and anesthesiologists are liberal in prescribing blood products. The purpose of this brief review is to draw the readers' awareness to the potential danger associated with blood transfusion and discuss existing alternative means of counteracting acute perioperative anemia.