Do we need autologous blood donation?

Abstract

The aim of preoperative autologous blood donation (ABD) was to reduce both the risk of transfusion transmitted disease and the need of blood from donors. Since ABD has been developed, the conditions of surgery and the criteria of choice have been modified thus leading to actualise the evaluation of this therapy. The first theoretical advantage of ABD is prevention of transfusion-transmitted disease namely viral infections such as HIV or hepatitis virus or emerging virus. Actually, the very low residual risk that remains from allogeneic transfusion after appropriate selection of donors, leukoreduction and nuclear acid testing does not argue for ABD. On the other hand, the risk of bacterial contamination must be taken in account for both ABD and homologous transfusion. A meta-analysis showed that ABD reduces the exposure to homologous transfusion (OR: 0.17). Clinical studies showed that patients who predonated autologous blood were more likely to receive any blood transfusions (autologous and/or allogeneic) than those who did not (OR: 3.31). More, the reduction of exposure to allogeneic transfusion may be questioned in view of prescription bias. Additionally, ABD is poorly cost-effective. It leads to significant blood wastage as in most of the studies about half of the units are discarded. In conclusion the interest of ABD has not been sufficiently evaluated. The interest of this therapy remains to be demonstrated.