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.
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Apr 12, 2016.References
- Vanderlinde ES, Heal JM, Blumberg N. Autologous transfusion. BMJ 2002; 324:772.
- 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.
- Yomtovian R, Kruskall MS, Barber JP. Autologous-blood transfusion: the reimbursement dilemma. J Bone Joint Surg Am 1992; 74:1265.
- 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.
- Kanter MH, van Maanen D, Anders KH, et al. Preoperative autologous blood donations before elective hysterectomy. JAMA 1996; 276:798.
- 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.
- 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.
- 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.
- Goldman M, Savard R, Long A, et al. Declining value of preoperative autologous donation. Transfusion 2002; 42:819.
- Axelrod FB, Pepkowitz SH, Goldfinger D. Establishment of a schedule of optimal preoperative collection of autologous blood. Transfusion 1989; 29:677.
- Mott LS, Bechinski J, Jones MJ. Autologous blood collection in anemic patients using low-dose erythropoietin therapy. J Natl Med Assoc 1997; 89:381.
- 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.
- 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.
- 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.
- Spiess BD, Sassetti R, McCarthy RJ, et al. Autologous blood donation: hemodynamics in a high-risk patient population. Transfusion 1992; 32:17.
- Stenhouse MA, Milner LV. Yersinia enterocolitica. A hazard in blood transfusion. Transfusion 1982; 22:396.
- Uhl L. Patient blood management: a 68-year-old woman contemplating autologous blood donation before elective surgery. JAMA 2011; 306:1902.
- Silvergleid AJ. Safety and effectiveness of predeposit autologous transfusions in preteen and adolescent children. JAMA 1987; 257:3403.
- Klein HG. Standards for Blood Banks and Transfusion Services. In: American Association of Blood Banks, 16th ed, Bethesda, 1994.
- Cregan P, Donegan E, Gotelli G. Hemolytic transfusion reaction following transfusion of frozen and washed autologous red cells. Transfusion 1991; 31:172.
- Richards C, Kolins J, Trindade CD. Autologous transfusion-transmitted Yersinia enterocolitica. JAMA 1992; 268:154.
- 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.
- College of American Pathologists, Comprehensive Transfusion Medicine Survey. Set J-C, 1992.
- Gerberding JL, Littell C, Tarkington A, et al. Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990; 322:1788.
- Mintz PD. Participation of HIV-infected patients in autologous blood programs. JAMA 1993; 269:2892.
- Yomtovian R, Kelly C, Bracey AW, et al. Procurement and transfusion of human immunodeficiency virus-positive or untested autologous blood units: issues and concerns: a report prepared by the Autologous Transfusion Committee of the American Association of Blood Banks. Transfusion 1995; 35:353.
- Vanston V, Smith D, Eisenstaedt R. Should patients with human immunodeficiency virus infection or chronic hepatitis donate blood for autologous use? Transfusion 1995; 35:324.
- Starkey JM, MacPherson JL, Bolgiano DC, et al. Markers for transfusion-transmitted disease in different groups of blood donors. JAMA 1989; 262:3452.
- Kruskall MS, Yomtovian R, Dzik WH, et al. On improving the cost-effectiveness of autologous blood transfusion practices. Transfusion 1994; 34:259.
- Goodnough LT, Price TH, Friedman KD, et al. A phase III trial of recombinant human erythropoietin therapy in nonanemic orthopedic patients subjected to aggressive removal of blood for autologous use: dose, response, toxicity, and efficacy. Transfusion 1994; 34:66.
- Etchason J, Petz L, Keeler E, et al. The cost effectiveness of preoperative autologous blood donations. N Engl J Med 1995; 332:719.
- Rutherford CJ, Kaplan HS. Autologous blood donation--can we bank on it? N Engl J Med 1995; 332:740.
- 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