Update on Transfusion Therapy

Abstract

The science and technology of transfusion have improved dramatically over the past decade. Improvements in screen ing for viral pathogens have reduced the risk of transfusion transmitted viral infections to historic lows. Newly recog nized entities, including the transfusion transmitted virus and Parvo viruses are being investigated as pathogens. There is increasing appreciation that bacterial infection and parasites may be transmitted via transfusion, and a variety of approaches are being developed to deal with them. Clin ical studies continue to conflict about what the ideal hemo globin for patients with cardiovascular disease should be, but several studies suggest that higher hematocrits may be beneficial. Factor deficiency may play a more important role in massive transfusion than previously believed. The impor tance of autologous predeposit of red cells and hemodilu tion may diminish as the blood supply becomes ever safer, but intraoperative salvage is likely to remain an important technique. Finally, although blood substitutes have been under development for more than 10 years, they have not yet become widely used in medicine. The few remaining products under development are presently in advanced clin ical trials but face a variety of clinical and economic obsta cles before they can rise to their potential.