Is There Still a Place for Autologous Blood Predonation?

Abstract

SUMMARYInterest in autologous blood procurement was stimulated in the 1980s by a renewed awareness that infectious diseases, including post‐transfusion hepatitis and human immunodeficiency virus (HIV), are transmissible by blood transfusion. Preoperative autologous blood donation (PAD), acute normovolemic hemodilution (ANH), and intraoperative/postoperative autologous blood cell recovery and reinfusion were each techniques identified and promoted in the surgical arena in response to medical and legal pressures to minimize allogeneic blood exposure.The role of autologous blood procurement in surgery continues to evolve based on improved blood safety, increased blood costs, and emerging pharmacologic alternatives to blood transfusion. PAD became accepted as a standard practice in certain elective surgical settings, such as total joint replacement surgery, so that by 1992, over 6% of the blood transfused in the U.S. was autologous. In contrast, ANH was rarely practiced and published data regarding its merits were scant. Subsequently, substantial improvements in blood safety were accompanied by a decline in PAD (Table 1) as well as by an interest in ANH as an alternative, lower‐cost autologous blood procurement strategy. Nevertheless, public perception of blood safety and the reluctance to accept allogeneic blood transfusion in the elective transfusion setting, along with emerging blood inventory shortages, continue to make the application of autologous blood procurement strategies a subject of ongoing debate. The current roles of these strategies are presented.