Approximately 12 million red blood cell units are transfused to nearly 4 million patients annually in the United States (1). The conservation of blood has historically arisen from awareness that the inventory of this resource is limited (2), as well as the knowledge that blood transfusion carries a risk (3). Estimates of current blood transfusion risks (4-12), and the costs of transfusion complications (13-17), are summarized in Table 1. In addition, emphasis on the costs of health care has raised issues related to the costs of blood transfusion (18, 19). Finally, recent guidelines have emphasized that in the elective transfusion setting, no blood transfusion is a desirable outcome (20, 21). Furthermore, these guidelines along with consensus conference recommendations (22) have emphasized that if blood is to be transfused, autologous (the patient's own) blood is preferable to allogeneic (from an anonymous, volunteer donor) blood. Thus, the costs of blood conservation, for which an increasing array of technologic procedures and products have become available (Table 2), have also become an issue (23). The purpose of this review is to provide an overview of emerging data on the cost-effectiveness of blood and blood conservation interventions in order to help identify areas important for future investigation.

hlS, Martin JW. Blood consenation and blood salvage. J Intensive Care Ned 1994;9:86-97.Autologous blood transfusion has been recommended as the blood of choice for surgical patients. Procurement of autologous blood can b e accomplished by utilizing one or more conservation interventions: preoperative autologous blood donation, acute preoperative hemodilution, and perioperative autologous salvage. Recent estimates of cost-effectiveness emphasize that blood conservation interventions need to be held accountable with regards to their costs as well as their benefits. Despite recent advances in blood safety, patients need to be informed of the relative risks of blood transfusion and blood conservation, so that P careful balance of the need for blood conservation along with an acknowledgment of the life-saving properties of blood can

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