The article by Parker et al. on red cell transfusion in obstetrics reveals major problems in the management of blood transfusion in obstetrics. Knowing that the obstetrical patient is prone to high, and often acute and unpredictable blood losses, there is an increased risk for blood transfusion in cases of severe anemia and cardiovascular problems. However, as described in this article, we have realized in our own clinical setting that a high number of red cells are transfused (along with other blood components) without strict criteria and/or cutoff levels; for example, in cases of minor or moderate anemia, where blood transfusion is not warranted. Therefore, strict criteria and guidelines have to be implemented and controlled locally. Indications of administered blood should be clearly documented by physicians. Finally, alternatives to blood transfusion such as intravenous iron must be considered on a more regular basis.

– Christian Breymann