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Reducing blood transfusion

Editor—The randomised controlled trial on mechanical methods of reducing blood transfusion in cardiac surgery by McGill et al is laudable, but we challenge the BMJ for highlighting this paper on the front cover with the headline: “Cell salvage reduces the need for a transfusion.”1 We believe that the journal has a responsibility not to exaggerate the perceived importance of findings, either in press releases or by other means.2 
 
The authors themselves highlighted the main limitations of the study in their discussion, and we believe that such declarations are important safeguards against widespread use of the described methods without further scientific evaluation. 
 
The authors comment on the high cost of transfusion, but they did not include a cost analysis in their study. We understand the risks associated with transfusion and agree that these in themselves may justify any added cost. However, introducing strict transfusion guidelines and monitoring their use is certainly a step that should precede the introduction of new equipment. 
 
We have been reinforcing transfusion guidelines for the past two years in our institution and are continuously monitoring blood transfusion in our hospital. Interestingly, when looking at a similar patient population to that of McGill et al, but lacking the research methods and statistics, we have achieved a similar decrease in use of all blood products, mainly by insuring that blood is transfused only when required and blood products given when need is documented (table). Despite our programme, blood products are still administered too often outside the hospital guidelines, and we think that we could decrease their use even further before introducing new expensive equipment to our routine practice. The BMJ 's cover may only reinforce incorrect practices by encouraging widespread use of techniques without common sense. 
 
We agree that the combination of acute normovolaemic haemodilution and cell salvage did not confer any benefit in this study, but McGill et al have not explored acute normovolaemic haemodilution as such and therefore no conclusion can be made with certainty about the absence of benefit of acute normovolaemic haemodilution itself. In the author's own words, this study adds to many others that are inconclusive because of the quality of the evidence. 
 
We believe that the BMJ 's cover, while attractive, may have mislead readers, and we therefore question the rationale behind such a decision.