Prospectus. Future trends in transfusion.

There are several emerging trends in perioperative transfusion that are promising in terms of clinical practice. These include modifications in transfusion practice, changes in blood bank procedures and philosophy, the use of autologous transfusion methods, and the development of new artificial blood substitutes. Refinement of current techniques will continue, and will be driven by several factors. The most significant recent changes in surgical practice relating to blood transfusion include a decreased reliance on the use of arbitrary transfusion triggers, and the increased use of various forms of autologous transfusion. Other clinical changes have been less obvious, such as changes in blood bank management practice. Similar factors drive the development of blood conservation strategies and artificial blood substitutes or O2 carriers. Both will play a role in reducing perioperative blood loss. The most likely scenarios involve use of blood substitutes in conjunction with various methods of blood conservation. Recent advances in blood banking have made the donor blood supply safer than ever before. Progress in the clinical setting and in the laboratory have widened the possibilities for treatment of perioperative blood loss, with attention to minimizing risk and cost, and maintaining safety for the patient.