Do We Still Need Preoperative Autologous Blood Donation? – It Is High Time for a Reappraisal!

Abstract

Preoperative autologous blood donation (PABD) can be an adequate solution to a patient’s problem before nonurgent surgery if a high (>10%) probability of perioperative blood transfusion exists in this individual case and, at the same time, pre-existing alloimmunization or a different ethnic background make it difficult to supply this patient with compatible red blood cell concentrates. In times of acute shortness of blood, when nonurgent surgery might be rescheduled and delayed, and in cases of extreme angst-ridden patients fearing homologous blood transfusion, PABD can be considered in rare individual cases as well. Nonetheless, in all these cases, the patient must be eligible for PABD, and the indication as well as potential contraindications have to weighted against each other in a thorough individual risk-benefit analysis. However, these are relatively rare cases. Apart from these and few other situations, PABD in our opinion should not be used because of high costs and logistic efforts, high wastage, considerable risks for the donor/patient on the one hand and miniscule benefits on the other hand. PABD cannot significantly contribute to the blood supply. PABD in error-free use, which is unrealistic, reduces the risk of transmission of known and unknown viral pathogens, but possibly not of bacteria. In real life situations, the residual risk for transmission of transfusion-relevant viruses such as HIV, HVC or HBV is not diminished by PABD. The same is true for clerical errors and ABO incompatibility or acute hemolytic transfusion reactions due to a mix-up of products. PABD reduces the risk of (allo)immunization and therefore has its indication in special clinical situations. PABD on the other hand increases the risks for the donor at the time of donation and afterwards. Autologous blood products seem to have higher rates of bacterial contamination. The risk for the patient to receive any transfusion perioperatively is increased due to the lower hemoglobin levels at admission (iatrogenic anemia) as well as due to a wrongly more liberal transfusion strategy in autologous hemotherapy compared to transfusion of homologous blood. A significant number of patients, who would never receive any transfusion perioperatively at all, enter the transfusion chain due to PABD procedures, facing the risks of a blood donor as well as the risks of a transfusion recipient.