In Reply:—  We thank Dr. de Saint Maurice et al.  for their comments regarding our editorial view1and share their concerns over perioperative deaths as a result of inadequate blood management. We could not agree more with their view that not measuring the hemoglobin concentration consecutively during major hemorrhage is substandard care, as is not treating severe hypovolemia or hypotension in such situations.

This is what patient blood management is all about; patient blood management is not “just say no to blood transfusions.” Patient blood management is based on three pillars: Detecting and treating preoperative anemia, reducing the loss of red blood cells perioperatively, and optimizing the treatment of anemia. Red blood cell transfusions may be administered if all other options have been used and the patient starts showing signs of inadequate oxygenation. Of course, the quick correction of hypovolemia, hypotension, tachycardia, and arrhythmia is an integral part of patient blood management.

It is of utmost importance not to confound the momentary helpful effect of red blood cell transfusion on hypotension and hypovolemia with an outcome benefit. Red blood cell transfusions are indisputably associated with an increase in mortality,2,3major adverse cardiac and noncardiac outcome,4acute lung injury,5nosocomial infection,5tumor growth,6duration of hospitalization, and cost.7 

Therefore, there is an urgent need for change, and the Governments of Western Australia and the Canton of Zurich, Switzerland, are to be congratulated again for taking the lead in sustainably implementing patient blood management and thereby improving patient outcome.

*University Hospital Zürich, Zürich, Switzerland.

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