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Preoperative autologous blood donation

INTRODUCTION

Preoperative autologous donation (PAD) is the most popular and widely used of the autologous options, which also include preoperative hemodilution and blood salvage. Interest in all forms of autologous transfusion, particularly PAD, mushroomed in response to the AIDS epidemic, beginning as early as 1983. By 1993, when participation in PAD peaked, approximately 6 percent of all blood collected in the United States was collected for autologous use. (See "Acute normovolemic intraoperative hemodilution" and "Intraoperative and postoperative blood salvage".)

BENEFITS

The most obvious benefit of PAD for the donor/patient is freedom from concern about infectivity of the blood. Assuming that the donor is not bacteremic at the time of donation and/or there are no clerical errors resulting in the inadvertent transfusion of the wrong unit of blood, the patient is also protected against hemolytic, febrile or allergic transfusion reactions; alloimmunization to erythrocyte, leukocyte, platelet or protein antigens; and graft-versus-host disease (GVHD). (See "Transfusion-associated graft-versus-host disease".)

An additional benefit is that erythropoiesis may be stimulated by repeated phlebotomies, thereby enabling the patient to regenerate hemoglobin at an accelerated rate after surgery.

The overall efficacy of PAD has been evaluated in both randomized trials and cohort studies [1]. A meta-analysis found that patients who underwent PAD were much less likely than controls to receive allogeneic blood (odds ratio 0.17) but were more likely to undergo any transfusion with autologous and/or allogeneic blood (odds ratio 3.0) [2]. The latter effect is due both to a lower hematocrit in patients undergoing PAD and a more liberal transfusion policy when using autologous blood.

DRAWBACKS

PAD programs are not without some drawbacks. Perhaps the most important is that autologous blood is considerably more expensive than allogeneic blood. This problem is compounded by the fact that current reimbursement programs (including Medicare) either deny the medical necessity of PAD or ignore the well-documented increase in cost [3].

                 

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Literature review current through: May 2013. | This topic last updated: Aug 22, 2012.
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References
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  1. Vanderlinde ES, Heal JM, Blumberg N. Autologous transfusion. BMJ 2002; 324:772.
  2. Forgie MA, Wells PS, Laupacis A, Fergusson D. Preoperative autologous donation decreases allogeneic transfusion but increases exposure to all red blood cell transfusion: results of a meta-analysis. International Study of Perioperative Transfusion (ISPOT) Investigators. Arch Intern Med 1998; 158:610.
  3. Yomtovian R, Kruskall MS, Barber JP. Autologous-blood transfusion: the reimbursement dilemma. J Bone Joint Surg Am 1992; 74:1265.
  4. Fontaine MJ, Winters JL, Moore SB, et al. Frozen preoperative autologous blood donation for heart transplantation at the Mayo Clinic from 1988 to 1999. Transfusion 2003; 43:476.
  5. Kanter MH, van Maanen D, Anders KH, et al. Preoperative autologous blood donations before elective hysterectomy. JAMA 1996; 276:798.
  6. Billote DB, Glisson SN, Green D, Wixson RL. A prospective, randomized study of preoperative autologous donation for hip replacement surgery. J Bone Joint Surg Am 2002; 84-A:1299.
  7. Devine P, Postoway N, Hoffstadter L, et al. Blood donation and transfusion practices: the 1990 American Association of Blood Banks Institutional Membership Questionnaire. Transfusion 1992; 32:683.
  8. Goodnough LT, Saha P, Hirschler NV, Yomtovian R. Autologous blood donation in nonorthopaedic surgical procedures as a blood conservation strategy. Vox Sang 1992; 63:96.
  9. Goldman M, Savard R, Long A, et al. Declining value of preoperative autologous donation. Transfusion 2002; 42:819.
  10. Axelrod FB, Pepkowitz SH, Goldfinger D. Establishment of a schedule of optimal preoperative collection of autologous blood. Transfusion 1989; 29:677.
  11. Mott LS, Bechinski J, Jones MJ. Autologous blood collection in anemic patients using low-dose erythropoietin therapy. J Natl Med Assoc 1997; 89:381.
  12. Nuttall GA, Santrach PJ, Oliver WC Jr, et al. Possible guidelines for autologous red blood cell donations before total hip arthroplasty based on the surgical blood order equation. Mayo Clin Proc 2000; 75:10.
  13. Mann M, Sacks HJ, Goldfinger D. Safety of autologous blood donation prior to elective surgery for a variety of potentially "high-risk" patients. Transfusion 1983; 23:229.
  14. Owings DV, Kruskall MS, Thurer RL, Donovan LM. Autologous blood donations prior to elective cardiac surgery. Safety and effect on subsequent blood use. JAMA 1989; 262:1963.
  15. Spiess BD, Sassetti R, McCarthy RJ, et al. Autologous blood donation: hemodynamics in a high-risk patient population. Transfusion 1992; 32:17.
  16. Stenhouse MA, Milner LV. Yersinia enterocolitica. A hazard in blood transfusion. Transfusion 1982; 22:396.
  17. Uhl L. Patient blood management: a 68-year-old woman contemplating autologous blood donation before elective surgery. JAMA 2011; 306:1902.
  18. Silvergleid AJ. Safety and effectiveness of predeposit autologous transfusions in preteen and adolescent children. JAMA 1987; 257:3403.
  19. Klein HG. Standards for Blood Banks and Transfusion Services. In: American Association of Blood Banks, 16th ed, Bethesda, 1994.
  20. Cregan P, Donegan E, Gotelli G. Hemolytic transfusion reaction following transfusion of frozen and washed autologous red cells. Transfusion 1991; 31:172.
  21. Richards C, Kolins J, Trindade CD. Autologous transfusion-transmitted Yersinia enterocolitica. JAMA 1992; 268:154.
  22. College of American Pathologists, Comprehensive Transfusion Medicine Survey. Set J-C, 1992.
  23. Covin RB, Ambruso DR, England KM, et al. Hypotension and acute pulmonary insufficiency following transfusion of autologous red blood cells during surgery: a case report and review of the literature. Transfus Med 2004; 14:375.