This is a very interesting retrospective, risk-adjusted, clinical outcome study examining the application of a sophisticated bloodless programme in medical and surgical patients. A large number of patients were enrolled and a reliable statistical analysis was performed. As mentioned by the authors, this is the first study reporting prosensity-matched, risk-adjusted outcomes of bloodless care in a population that does not include only cardiac surgery patients.

Applying this well-described bloodless programme, assessing and analysing a variety of clinical outcomes for patients who choose to avoid allogeneic blood transfusion (ABT) and comparing them to those of patients who accept ABT, the authors shown that there are similar and even improved overall results in the bloodless group, including a significant cost reduction.

These findings clearly suggest that these multidisciplinary practices may not only be safely used in all patients wishing to avoid ABT, but also in other patient groups, because of significant overall benefits and minimal risks.

– Constantine Vagianos

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