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In Reply: We agree with Drs Sarani and Gracias that the concerning results from the HBOC trials should not deter future research on technologies to minimize or avoid allogeneic transfusion. We also agree with Dr Sauaia and colleagues that there may be additional circumstances such as emerging pathogens and national emergencies that threaten the adequacy or quality of the US blood supply. However, it is important to assess the clinical consequences of each threat or harm with robust and ethical methodology.

With respect to the deleterious effects of allogeneic blood, there are too few definitive clinical trials to justify claims that allogeneic blood is harmful compared with alternative technologies. Although a plethora of cohort studies have shown transfusions to be associated with deleterious consequences, these studies are highly susceptible to confounding by indication, as patients with higher acuity receive a higher number of transfusions.^1-3 Such studies are hypothesis-generating at best. . . . [Full Text of this Article]

Dean Fergusson, MHA, PhD
dafergusson@ohri.ca

Lauralyn McIntyre, MD, MSc
Ottawa Health Research Institute
Ottawa, Ontario, Canada

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