The study of Lacroix et al. is
well-designed. The results are valid and the conclusions are sound. It is a
further study showing that a restrictive transfusion strategy is not
disadvantagous for stable patients in pediatric intensive care units. However,
it also shows that a liberal transfusion strategy is not disadvantageous. The
better outcome in case of restrictive transfusion strategy in several other
studies may have been due to the quality of the blood units transfused (storage
duration, leukocyte contamination, additive solution). In the study of Lacroix
et al., leukodepleted RBCs stored for about 2 weeks in average, which is rather short, were administered. As long as it is unclear which patients benefit from transfusion, it seems not to be inacceptable to follow a more liberal strategy in selected cases (e.g. instable patients, patients with cardiovascular
disease or after brain injury) when leukodepleted RBCs of good quality are
transfused. Nevertheless, in their Editorial, Corwin and Carson make a very important
comment with which I fully agree: red cell transfusion should no longer be regarded
as “may help, will not hurt” but should be approached as “first, do no harm.”

– Volker Kretschmer