Blood and blood substitutes: current practice.

We have seen that the vast majority of previously healthy patients can tolerate a significant reduction in red cell mass without adverse effect on oxygen consumption. For these patients, volume replenishment with electrolyte solutions will adequately restore blood volume and cardiac output. Colloid solutions offer no advantage over electrolyte solutions, certainly are more expensive and may even be harmful. For patients who need restoration of oxygen-carrying capacity, washed, packed red cell administration is the therapy of choice, and frozen, thawed red cells represent optimal utilization of a scarce commodity. Other components, such as fresh frozen plasma, factor VIII or IX concentrates and platelets, are not indicated unless a specific deficiency exists. Autologous blood, using one of the techniques described above, is a safe and effective means of replacing lost red cells in special circumstances. The use of these techniques, combined with realistic ordering of homologous blood for elective surgical procedures, should act in concert to relieve shortages of blood.