Response

To the Editor:

We thank Dr Davidson for his interest and thoughtful comments regarding our review.¹ In response to his first comment, we agree that there are important limitations to the study by Müller et al.² Its small size and limited patient population diminishes its generalizability, but this does not mean that its findings should be disregarded. The fact that only one in 81 patients enrolled had a major bleeding complication echoes the low incidence of major bleeding complications found in other studies, which is an important point to consider when weighing the risks and benefits of the routine use of preprocedural blood transfusions. We also agree with the second point that if a transfusion is to be given, it should not be done to fix a laboratory test result but should be carried out with the intention of reducing patient risk. We cannot, however, dismiss the fact that blood tests, specifically prothrombin time or international normalized ratio, are often the trigger used by physicians to give transfusions prior to an invasive procedure.³ Therefore, we believe it is important to be aware of the limitations in “fixing” laboratory-based coagulopathy with fresh frozen plasma transfusions. Even more important, though, is awareness of the potential harm associated with transfusion of blood products. The potential complications— including risk of infection, volume overload, lung injury, and increased mortality in some cases—are well documented. Given the relative paucity of evidence supporting the routine use of transfusions to decrease bleeding risk, we maintain that the overt risk of harm from transfusion should bring into question the utility of this practice. We welcome and encourage further research on this topic to help guide clinical decision-making.