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Patient Blood Management From Blood Product to Patient-centered Care

Evidence has shown that the clinical practice of liberal use of allogeneic blood transfusion is in dire need of reassessment. Concerns regarding the safety and efficacy of allogeneic blood transfusions, their impact on patient outcomes, and the astounding costs and challenges associated with supply reserves of blood products have fueled the quest for alternative strategies to reduce blood use while meeting the needs of a growing (and increasingly aging) population (Supplemental Digital Content 1, http:// links.lww.com/ASA/A333). Blood has always been perceived as a ‘‘life saver’’ and, as such, is an emotional topic. The revisiting of transfusion practices has highlighted the potential risks associated with allogeneic blood (Table 1) and offers a lack of convincing evidence of its benefit in nonhemorrhaging and many transfusion-dependent patients. The evidence highlighting the association of allogeneic blood transfusion with worse outcomes—not just the known and relatively rare side effects of transfusion, but significant and substantial negative impact on mortality, morbidity, and length of hospital stay—is rapidly growing.