Use and abuse of blood.

This paper reviews the use and abuse of blood and blood products. Source of misuse of cell concentrates originates from the endeavour of physicians to correct the peripheral blood count irrespective of signs and symptoms of the patient. In chronic anaemias in the steady state, it is not the red cell count and haemoglobin level of the peripheral blood but the capacity of blood to release oxygen which is the decisive factor in determining the clinical severity of anaemia. There is no "critical" platelet or granulocyte value under which patients have to be transfused. A decision to give any blood derivative has to be based on the correct diagnosis of the underlying disease, taking into account all risk and benefit factors. Indications for albumin and immunoglobulins are well defined and there is a definite need to fight against their unjustified use. There is still a growing need for F VIII concentrates. The production of cryoprecipitate, from plasma of unpaid voluntary donors, the safest small pool F VIII concentrate, should be increased in every country. The use of high purity commercial F VIII concentrates should be restricted to the treatment of significant haemorrhages in severe haemophiliacs. Efforts should be concentrated on producing safe virus-free purified concentrates. The clinical use of F IX is well established while indications for AT-III are still under study. There is a growing need for specific immunoglobulins, protease inhibitors and therapeutically useful enzyme preparations.