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Contrary to their benign image, blood transfusions are overused and often harm patients, expert says:

REFUSE at your own risk: for years that's the message doctors have relayed to Jehovah's Witnesses and others who've declined blood transfusions.
But transfusions are not the wonder procedure of popular, or even medical profession, imagination. Mounting evidence shows they significantly increase the risk of post-operative complications - including infections, kidney failure, lung injury and death.

Yet instead of being saved as a last resort, they are still being performed when other safer options could be used instead.

In fact, more than 25 per cent of blood transfusions currently performed are unnecessary, according to a visiting US expert who spoke at the annual scientific meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) two weeks ago.

Internationally renowned emergency medicine and anaesthiology professor Bruce Spiess told the conference that while blood transfusions have long been "believed to be helpful and a pillar of modern medicine'', there was now relatively little evidence to support such claims.

"Drug options are carefully tested and regulated through prospective, randomised double-blind testing, but blood transfusion stands apart,'' Spiess says. "It has never been safety or efficacy tested.''

It's a point that has been echoed by several Australian experts, including anaesthesists associate professor Larry McNicol and doctor Peter McCall at Austin Health in Melbourne.

"From the point of view of the risk of transmitting infections, blood transfusions are safer than they have ever been,'' McCall says.

"However, there is an ever-increasing body of research about adverse outcomes in association with them. Still there is a tendency to think that blood transfusions are mystical and lifesaving, and it is better to give them than to withhold them.''

At the same meeting the government announced that by 2010 all blood will be processed to remove white blood cells, known as leuko-reduced blood, which has been shown to dramatically reduce complications and is already in widespread use in Canada, New Zealand, Western Europe and elsewhere.

"There are three randomised controlled studies in heart surgery, where patients who were deemed appropriate to be transfused got either leuko-reduced blood or blood with white cells present,'' Spiess says.

"The death rate in those with leuko-reduced blood was roughly half that in those with blood with white cells,'' Speiss says. "In the patients that got no blood, there were no deaths at all.''


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