The issue of blood transfusion was raised in an excellent
article by Erik Fransen et al1and by the editorial
comment of Harold L. Corwin.2 One more point needs to be
added to the discussion. It is generally agreed that routine blood
transfusion is of no merit. Most physicians and surgeons also agree
that hematocrit or hemoglobin values alone are not often indications to
accept the hazards of blood transfusion. Physiologic impairment related
to inadequate oxygen transport, secondary to decreased circulating red
blood cells, seems to be the current major indicator for transfusion.
Unfortunately, there is still a philosophy that, when transfusion is
indicated, a minimum of two units of packed red cells should be given
to an average size adult. If we really believe that the hazards and
risks of transfusion are directly related to the number of units
administered, it would seem reasonable to discard the two-unit minimum.
When a patient reaches a point where augmentation of the red cell mass
is indicated and active bleeding is not present, a single unit will
often turn the tide. If the observed improvement is inadequate, a
second or third unit can be given. The point is, however, if we are to“
do no harm,” we should administer only the amount of blood
actually needed by the patient. Giving two units of red cells
automatically, in every case of adult transfusion, as was the teaching
when transfusion indications were less stringent and we knew less about
associated hazards, is no longer reasonable and should be avoided.