Surgical blood conservation: Preoperative autologous blood donation
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
Preoperative autologous donation (PAD) remains the most widely known, though perhaps no longer the most widely used, of the autologous options for surgical blood conservation, which also include intraoperative hemodilution and blood salvage. (See "Surgical blood conservation: Intraoperative hemodilution" and "Surgical blood conservation: 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 intended for autologous use. This percentage subsequently declined to less than 1 percent of blood collections. A variety of factors may have contributed to the decline in PAD, including a realization that a large portion of autologous blood was not administered (and therefore wasted) and increasing confidence in the safety of the blood supply. (See "Blood donor screening: Medical history" and "Blood donor screening: Laboratory testing" and "Blood donor screening: Procedures and processes to enhance safety for the blood recipient and the blood donor".)
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 (more theoretical than practical) 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 . 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) . The latter effect is due both to a lower hematocrit in patients undergoing PAD and a more liberal transfusion policy when using autologous blood.
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- INDICATIONS AND CONTRAINDICATIONS
- PROGRAM SPECIFICS
- Physician request
- Iron supplementation
- Informed consent
- Donor criteria
- Serologic testing
- INDICATIONS FOR TRANSFUSION
- CONTROVERSIAL AREAS
- Extent of testing
- - Arguments in favor of minimal or no testing
- - Arguments in favor of complete testing
- Release of infected units
- - Rationale for releasing infected units
- - Rationale for not releasing infected units
- - Participation by known infectious donors
- Crossover (release to other recipients)
- - Safety issues
- - Logistical problems
- - Cost issues
- Role of erythropoietin
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS