1. Transfusions are inherently hazardous

The blood collection industry has done a remarkable job of reducing the risk of viral transmission through donor screening and blood testing. While it is true that blood products are the safest in history, transfusions are not risk free and cause some degree of harm in every patient due to the physical properties of stored blood and because of impairments in immune system function. The leading causes of transfusion-related morbidity and mortality are unrelated to viral transmission and include bacterial contamination of platelets (1:2000- 3000 transfusions), transfusion errors from patient misidentification (1:16,000- 19,000) and transfusion related acute lung injury (TRALI) (1:1000- 5000). Analogous to chemotherapy, blood transfusions can improve outcomes but only when used in the right patient for the right indication and in the right dose.