Physiologic transfusion triggers and massive transfusion

Blood transfusion is often a life saving intervention, but can also be harmful. Restrictive transfusion protocols have recently been developed with a post transfusion target haemoglobin level of 70-100 g/l. Whether haemoglobin level on its own is enough to guide our transfusion policy is an important issue. This review was aimed to look at other possible, so called physiological indicators of blood transfusion what clinicians can be used in addition to haemoglobin during their everyday practice. In the second part of the paper the problems of the management of massive bleeding are reviewed. In both cases, a complex approach is required taking into consideration physiological changes in order to individualize treatment and hence avoid harm that can be caused by unnecessary transfusion of blood products