Transfusion érythrocytaire et de produits sanguins hémostatiques : de la chirurgie programmée à la transfusion massive

Very few randomized controlled studies have been published on the benefits and risks of red cell and hemostatic blood product transfusions, whether during elective surgery or massive transfusion. The rare randomized trials on erythrocyte transfusion during elective surgery suggest that, overall, morbidity (including cardiac morbidity) and mortality, along with hemodynamic, respiratory and oxygen transport variables, are comparable when a restrictive (threshold between 7 and 8 g/dL) or a liberal (threshold of 10 g/dL) transfusion strategy are used. When considering massive transfusion, one should distinguish between elective surgery where the situation is controlled (normovolemia, normothermia, on-going management, etc.) and major trauma (hypovolemia and shock, hypothermia, acute coagulopathy of trauma, etc.). Unfortunately, no randomized trial is available to guide clinicians under the latter circumstances. The use of high hemostatic blood product/red blood cell transfusion ratios is not evidence-based but may be beneficial under certain but uncommon circumstances, particularly in the civilian (non-military) setting. Most recommendations on transfusion practice are not evidence-based. High quality clinical trials in different patient populations (including trauma and massive transfusion) must become available in order to determine optimal transfusion practices.