Blood Transfusions and Associated Risks
Blood transfusions are not without risk, such as acute transfusion reactions, ranging from mild to life-threatening, such as mild urticaria, acute haemolytic reactions, transfusion-associated circulatory overload and transfusion-related acute lung injury35. In several cases, the risk is greater when transfusing blood products versus management without transfusion. Engoren et al. found that even after comorbidities, age and additional confounding variables were accounted for, the 5-year mortality rate had increased by 70% in patients that received a blood transfusion compared to those who did not36. Similarly, research including 10,289 patients receiving blood transfusions demonstrated, after controlling factors such as demographics and comorbidities, a reduction, not only in immediate, but in long-term survival37. Furthermore, when haematocrit is low, theoretically a patient would benefit most from a blood transfusion, however, this was found not to be the case and a low haematocrit is associated with a higher complication and mortality rate38. It is imperative that clinicians are able to optimise patient care, especially for Witness patients, at all stages of treatment in order to avoid poorer outcomes.