Blood transfusion is associated with increased morbidity and mortality and numerous reports have emphasised the need for reduction. Following this there is increased attention to the concept of patient blood management. However, bleeding is relatively common following cardiac surgery and is further enhanced by the continued antiplatelet therapy policy. Another important issue is that cardiopulmonary bypass leads to haemodilution and a potential blood loss. The basic role of blood is oxygen transport to the organs. The determining factors of oxygen delivery are cardiac output, haemoglobin, and saturation. If oxygen delivery/consumption is out of balance, the compensation mechanisms are simple, as a decrease in one factor results in an increase in one or two other factors. Patients with coexisting cardiac diseases may be of particular risk, but studies indicate that patients with coexisting cardiac diseases tolerate moderate anaemia and may even benefit from a restrictive transfusion regimen. Further it has been shown that patients with reduced left ventricular function are able to compensate with increased cardiac output in response to bleeding and haemodilution if normovolaemia is maintained. In conclusion the evidence supports that each institution establishes its own patient blood management strategy to both conserve blood products and maximise outcome. 1. Status in Frequency of Transfusion and Impact on Outcome in Cardiac Surgery The concept of patient blood management is gaining increased attention. During the last decade numerous reports have emphasised the need for reductions in transfusions of blood and blood products as allogeneic red blood cell (RBC) transfusions are associated with increased morbidity and mortality [1–10], increased risk of severe postoperative infections [5], adverse effects or risk of transferring pathogens [11, 12], relatively high costs, and shortage of blood bank products [6, 12–14]. Postoperative severe bleeding is relatively common following cardiac surgery compared to other surgical specialties and is considered a serious complication associated with increased morbidity and mortality [14–21]. Within the cardiac surgery population, patients with advanced age and long cardiopulmonary bypass (CPB) are especially at risk of postoperative bleeding [18, 19]. Moreover, it is well known that excessive bleeding may be caused by surgical factors and impaired haemostasis due to enhanced fibrinolysis, platelet dysfunction, haemodilution, acidosis, hypothermia, and consumption of coagulation factors as well as the surgical trauma
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