ABSTRACT
Blood is a key component of surgery and treatment of injury, and its availability is critical for survival in the presence of severe blood losses. Its present use under conditions of optimal medical care delivery is one unit (0.5 l) per 20 person-year. On a world-wide basis, however, its availability and use is limited to one unit per 100 person-year according to statistics from the World Health Organization. The gap between current optimal need and actual availability is further aggravated by the fact that the blood supply in many locations is not safe. Even in conditions of optimal testing and safeguards, blood per se has a number of inherent risks [Dodd, 1992], ranging from about 3% (3 adverse outcomes per 100 units transfused) for minor reactions,
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to a probability of 0.001% of undergoing a fatal hemolytic reaction. Superimposed on these risks is the possibility of transmission of infectious diseases such as hepatitis B (0.002%) and hepatitis non-A non-B (0.03%). The current risk of becoming infected with the human immunodeficiency virus (HIV) is about 1 chance in 400,000 under optimal screening conditions. These are risks related to the transfusion of one unit of blood, and become magnified in surgical interventions requiring multiple transfusions.
