Autologous Transfusion and Directed Donations: Current Controversies and Future Directions

Abstract

HE PRACTICES of autologous transfusion and directed donation have become so com­ monplace in transfusion medicine that a review of these subjects may be most useful in highlighting unresolved issues. Most of these remain points of contention because of a lack of substantial data to address underlying issues. By reconsidering that which is known and that which is yet to be deter­ mined in these rapidly evolving areas of transfu­ sion medicine, a further appreciation of the appro­ priate roles of these two methodologies may be gained. SAFETY IN TRANSFUSION The primary motivation behind the recent up­ surge in interest in autologous transfusion and di­ rected donations is transfusion safety. The defini­ tion of safety has different elements for different participants in the transfusion process. For the pa­ tient, risk-free medical therapy is the goal-albeit unrealistic-and any steps that could be taken to eliminate, reduce, or control risks are sought, sometimes with intense perseverance. For physi­ cians, limitation of risk is also important, although avoidance of litigation may be an important factor as well. For blood collection agencies, these con­ cerns must be melded with the overall mission of its operation, which, until recently, may have been defined primarily in terms of volunteer homolo­ gous blood products. The ancient dictum, primum non nocere, con­ tinues to be of practical utility in transfusion med­ icine. Therapies should be applied in a judicious, circumspect manner so that their expected benefits outweigh their potential risks. The understanding of fa<::tors to be entered into the transfusion equa­ tion of risks and benefits has undergone dramatic changes in the last 5 to 10 years. The messages of transfusion medicine consultations-transfuse