Challenges of meeting the future blood transfusion requirement in England and Wales. Autologous blood transfusion could become an adjunct to the UK blood transfusion program in the future

Abstract

SUMMARY As a resource, allogeneic blood has never been more in demand than it is today. Escalating elective surgery, an aging population, periodic shortages arising from a fall in supply, old and emerging threat of transfusion-transmissible infections and spiraling costs because of various safety introductions have all conspired to ensure that allogeneic blood remains very much a vital but limited asset to the National Health Service. However, there are increasing demands for alternatives/complementary strategies to allogeneic blood transfusion. Autologous transfusion, predeposit autologous donation, acute normovolemic hemodilution and perioperative cell salvage is reliable, cost-effective, safe, does not involve type and screen, not associated with isoimmunization to foreign proteins, is indicated in patients with rare blood groups or complex red cell antibodies, comes handy for some religious sect like the Jehovah's Witnesses as well as being suitable in a significant number of patients undergoing elective surgeries. Autologous transfusion improves postoperative microcirculation, tissue perfusion and reduces the risk of thromboembolism. Benchmarking transfusion activity, ensuring that it is clinically indicated and justified, will help eliminate inappropriate use of blood products and help conserve our allogeneic blood stock. Erythropoietin (EPO) has drastically and significantly altered red cell transfusion practices. There might be many patients groups who would benefit from the use of EPO analogues and thus help conserve the allogeneic blood stock for patients in whom EPO is contraindicated. There is need to formulate policies on ways to seriously and innovatively attract and retain new donors. The National Blood Service and indeed the Department for Health can do well by promoting the use of autologous blood and other alternatives therapies to complement the UK allogeneic blood transfusion program in a bid to solving the periodic and envisage future shortages in allogeneic blood particularly with an aging UK population and increasing concerns about safety arising from old and emerging transfusion-transmissible infections. This will maximize the use of the limited allogeneic blood resource particularly for patients in whom autologous blood transfusion is contraindicated.