Preoperative Autologous Blood Donation – Efficacy, Effectiveness, Efficiency

Abstract

Background: The diminishing risks of allogeneic transfusion such as substantial reduction in transfusion-associated infections or prevention of immunosuppression and the recognition of limited financial resources for health care measures cast doubt on the value of preoperative autologous blood donation (PABD) for public health. Material and Methods: The epidemiological concept of efficacy, effectiveness, and efficiency has been applied to PABD. The results of hitherto published studies are summarized and commented. Measures to further improve the cost-effectiveness of PABD are presented and evaluated. They comprise limiting of serological screening or renunciation of component preparation of autologous units in appropriate cases. Results: With regard to the reduction of allogeneic transfusions, the efficacy of PABD appears to be proven in colorectal cancer surgery, knee and hip arthroplasty, and liver resection. PABD is possibly efficacious in most other elective surgical interventions with significant, anticipated blood loss. PABD is ef-fective, i.e. it extends quality-adjusted life expectancy in these cases if there is no significant risk attributable to donation or a high statistical or individual risk of allogeneic transfusion. PABD is probably efficient, i.e. cost-effective, in case of low patient age, low production costs of the autologous deposit, high transfusion probability, and low donation risk. Conclusions: Published studies do not reflect the current situation. The safety of allogeneic blood has improved significantly, with regard to transfusion-transmissible infections owing to intensified testing and with regard to immunosuppression owing to leukocyte depletion methods. On the other hand, not all feasible cost con-tainment measures have been applied to PABD. Thus, the cost-effectiveness of PABD is still at issue. Further carefully con-trolled studies are needed.