Autologous Blood Donation Research Articles

Präoperative Eigenblutspende und intraoperative Autotransfusion bei Erstimplantationen von Hüftendoprothesen - Eine retrospektive Studie

The records of a total of 102 patients who underwent primary total hip replacement during 1987-88 were evaluated retrospectively. 36 patients had donated 1-3 units of whole blood preoperatively. Surgery was performed with the use of a device for intraoperative autotransfusion (IAT). Another 25 patients without preoperative autologous blood donation were operated with the use of IAT. None of these techniques was available for the remaining 41 patients. The mean perioperative blood loss and the mean volume of transfused blood were 1400 ml and 1000 ml respectively. Equal quantities of blood were lost intra- and postoperatively, whereas only one fifth of transfused blood was given intraoperatively. Homologous blood transfusion was not required in 32% of the patients for whom autologous blood was not available. However after preoperative autologous blood donation, 95% of the 2-unit donors and 100% of the 3-unit donors could be operated without homologous blood transfusion. Autologous blood donation did not increase the need for homologous blood transfusions. With the use of IAT it was only 20% of the patients that at least 500 ml of blood were salvaged for retransfusion. On the basis of these findings, elective primary total hip replacement would seem to be the ideal operation to be performed after preoperative autologous blood donation and, whenever possible with the use of IAT. The desirable ratio of 1,5:1 for the units of blood to be crossmatched preoperatively vs. units transfused perioperatively can be achieved solely by preoperative donation of 3 units of autologous blood.

Efficacy of Intraoperative Cell Saver in Decreasing Postoperative Blood Transfusions in Instrumented Posterior Lumbar Fusion Patients

A retrospective study. To determine the efficacy of using intraoperative cell saver in decreasing the need for blood transfusion. Lumbar spine surgery is associated with potential large intraoperative blood loss, which may put patients at risk for blood transfusions. Preoperative autologous blood donation mitigates the need for allogenic blood transfusion, but does not eliminate it. Cell-saver use has been advocated to further reduce the need for transfusion, but recent reports have called its efficacy into question. Data were collected from 188 patients undergoing consecutive instrumented lumbar laminectomy and fusion. One hundred and forty-one of these patients had cell saver used during their procedures, whereas 47 did not. In addition, previously published data from similarly treated patients were used for analysis. Operative blood loss, autologous and allogenic blood transfusions, discharge hematocrit, and patient factors were analyzed. A significant increase in the number of blood transfusions was found in the cell-saver group. The cell-saver group also had a significantly increased blood loss compared with the non-cell-saver group. Using analysis of covariance, we determined the effect of blood loss on the need for transfusion. The results showed that correcting for blood loss eliminated the significance in the transfusion difference, but cell saver still was not able to decrease the transfusion need. Comparing our current results with our previously published results also demonstrated no benefit of cell saver use. Use of cell saver in instrumented lumbar fusion cases was not able to decrease the need for blood transfusion. Cell-saver use was associated with a significantly higher blood loss.

No changes in infliximab levels in blood stored for preoperative autologous blood donation

Rheumatoid arthritis (RA) patients requiring total joint arthroplasties under administration of infliximab, which may remain in donated blood if preoperative autologous blood donation (PABD) is undertaken for the surgery, may risk infection. We clarified infliximab hemokinetics in blood stored for such patients. A 20-ml blood sample was obtained from each of the ten RA patients receiving infliximab at just after administration and at 2 and 4 weeks following the administration of infliximab, mixed with 2.8 ml citrate-phosphate-dextrose-adenine (CPDA-1) and stored at 4–6°C. Plasma levels of infliximab in the stored blood were measured just after-mixture with CPDA-1, and at 2 and 4 weeks following the start of storage. Serum levels were also measured just before infliximab administration and at each phlebotomy. The plasma infliximab levels in the stored blood remained close to their original serum levels at the time of each corresponding phlebotomy, only somewhat influenced by dilution of CPDA-1, and sustained for 4 weeks following the start of storage, unlike in vivo, where levels decreased. This suggests that in order to prevent side effects, the later after infusion of infliximab the phlebotomy occurs, the better, and that the amount of stored blood transfusion should be consistent with that of blood loss.

Preoperative Autologous Blood Donation for Cardiac Surgery in Children

Preoperative autologous blood donation has been shown to reduce homologous blood transfusion in cardiac operations, but there have been few reports of its use in children. Of 50 children aged 6 months to 5 years (weight, 6.1-14.8 kg) undergoing primary cardiac surgery for simple anomalies, 23 donated autologous blood before surgery, the other 27 were age and weight-matched controls. Two donations of 10 mL x kg(-1) each were collected via the femoral vein under mild general anesthesia 12 +/- 5 and 19 +/- 7 days preoperatively. No complications related to autologous blood collection were observed. Homologous blood use was significantly less in the group given autologous blood (4.3%) compared to the control group (44.4%). There was no significant difference in hemoglobin levels between groups before, during or after the operation. Preoperative autologous blood donation appears to be safe and effective in reducing homologous transfusions, even in children weighing less than 15 kg.

One-stage Bilateral Total Joint Arthroplasty: A Prospective, Comparative Study of Total Hip and Total Knee Replacement

This prospective study compared the incidence of minor and major complications in 50 patients (100 joints) undergoing bilateral total knee arthroplasty (TKA) with 50 patients (100 joints) undergoing bilateral total hip arthroplasty (THA). Gender, comorbidities, American Society of Anesthesiologists scores, and body mass indices were similar in both groups. There was no difference in preoperative hemoglobin, operative time, anesthetic management, postoperative surveillance, and hemoglobin at discharge. However, the need for allogenic blood transfusion, despite preoperative autologous blood donation and retransfusion, was high for both groups (34% for bilateral TKA and 20% for bilateral THA. Bilateral THA patients had lower rates of total major and minor complications than bilateral TKA patients. Although cementless bilateral THA and cemented bilateral TKA can be performed efficiently and with relative safety in a select group of patients, the high rate of minor complications and in particular the need for allogenic transfusion in both groups is concerning and should be discussed with patients before surgery.

Quality management in autologous blood donation

In many anaesthesia departments, the autologous transfusions concept is an integral part of the perioperative measures catalogue. All patients benefit from this procedure, especially those who face an operation during which much blood will be lost. If a patient donates his/her own blood for their operation, there should not be any increase in risk to this patient. By employing contemporary quality management practices, including computer technology, the quality of the execution and management of the components as well as the quality of the patient care can be evaluated according to the quality of the structure, process and results. By this assessment the efficiency of the procedure can be confirmed and the advantages of using this technique, when utilised by an anaesthesiologist experienced in transfusion, can be underlined. An overview of the pre-existing and expected perioperative risk is of special advantage to the anaesthesiologist to make a realistic and effective decision regarding the possibility of safely processing the autologous blood donation concept.

Predonated autologous blood transfusion in elective orthopaedic surgery: A Hospital experience

Background: The use of homologous blood carries significant risk of viral infections and immune-mediated reactions. Preoperative autologous blood donation is an attractive alternative to homologous transfusion and has become common in elective orthopaedic surgery. Objective: To present our experience with the use of preoperative autologous blood donation program in elective orthopaedic surgery. Design/ Setting: A prospective study of patient charts and blood bank records carried out between March 1998 and August 1999 at the Department of Orthopaedic Surgery, Yopougon Teaching Hospital, Abidjan, Côte d\'Ivoire. Patients and methods: Twenty patients scheduled for elective orthopaedic procedures entered the program. There were 13 men and seven women with a mean age of 33.1 years. Fifteen of them were operated on and transfused. Main outcome measures: The number of units of blood collected, autologous or homologous transfusion requirements, side effects encountered during donation and transfusion of blood were documented. Results: Of the 62 units requested 57 (91.9%) were collected. We were able to meet 86.7% of transfusion requirements with autologous blood. The incidence of homologous transfusion was 13.3%. Thirty-eight (66.7%) units were transfused. The rate of wastage of units was 33.3%. There were no major complications as a result of the patients either giving their own blood or receiving any blood products. Conclusions: This study confirms that autologous blood transfusion is an effective way of reducing the need for homologous blood. The procedure of preoperative autologous blood donation is cost effective, safe, and should be widespread. Keywords: Autologous blood, Elective orthopaedic surgery, Homologous blood, TransfusionNigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp.52-54

Preoperative autologous blood donation in primary total knee arthroplasty: critical review of current indications

Preoperative autologous blood donation (PABD) is a well established transfusion practice in elective orthopaedic surgery, involving immunologic and infective advantages but also involving exposure to not negligible risks, and costs as well. The aim of this study was to assess the real need for blood transfusions in primary total knee arthroplasty (TKA). Between January 2000 and July 2005, 214 patients underwent primary unilateral TKA. Altogether, 416 autologous blood units were collected, however only 47 (11.3%) were transfused. Thirty-eight patients (17.8%) received autologous blood, while 4 of them (10.5%) also received allogeneic blood. Based on the results of this study, PABD should be recommended in well selected patients undergoing TKA: older female patients with a low basal haemoglobin level.

No changes in infliximab levels in blood stored for preoperative autologous blood donation

Rheumatoid arthritis (RA) patients requiring total joint arthroplasties under administration of infliximab, which may remain in donated blood if preoperative autologous blood donation (PABD) is undertaken for the surgery, may risk infection. We clarified infliximab hemokinetics in blood stored for such patients. A 20-ml blood sample was obtained from each of the ten RA patients receiving infliximab at just after administration and at 2 and 4 weeks following the administration of infliximab, mixed with 2.8 ml citrate-phosphate-dextrose-adenine (CPDA-1) and stored at 4-6 degrees C. Plasma levels of infliximab in the stored blood were measured just after-mixture with CPDA-1, and at 2 and 4 weeks following the start of storage. Serum levels were also measured just before infliximab administration and at each phlebotomy. The plasma infliximab levels in the stored blood remained close to their original serum levels at the time of each corresponding phlebotomy, only somewhat influenced by dilution of CPDA-1, and sustained for 4 weeks following the start of storage, unlike in vivo, where levels decreased. This suggests that in order to prevent side effects, the later after infusion of infliximab the phlebotomy occurs, the better, and that the amount of stored blood transfusion should be consistent with that of blood loss.

Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied

In total knee arthroplasty surgery, a blood conservation program is applied as a normal clinical practice to avoid allogenic transfusions. The objective of this study was to assess the effectiveness of tranexamic acid to reduce transfusions in total knee replacement even when a blood conservation program is applied. In a double-blind prospective study the patients scheduled for total knee arthroplasty were included in a well-established blood conservation program and then randomly assigned into two groups: In tranexamic acid group, 10 mg per kg ev bolus followed by 1 mg per kg per hour perfusion was administered, while in the control group, saline was given matching the protocol. Ninety-five patients were included (tranexamic acid group, 46; control group, 49). Thirty-three patients (34.7%) underwent preoperative procedures to reduce transfusions: presurgical autologous blood donation (12), recombinant erythropoietin (6), and elementary iron (15); postoperative drain for reinfusion was allocated in all the cases. Total blood loss on the fourth postoperative day was [mean (+/-SD)] 1744 (+/-804) mL in controls compared with 1301 (+/-621) mL in the tranexamic acid group (p < 0.05). Eleven units of blood were transfused (6 patients) in the control group versus one in the tranexamic acid group (p < 0.05). Only 2 patients (4%) in the tranexamic acid group received reinfusion of blood recovered by drains compared with 36 (73%) in the control group (p < 0.0001). No thromboembolic complications were detected. Tranexamic acid reduces blood losses and transfusion requirements even when a blood conservation program was used and it questions the usefulness of the postoperative reinfusion drains.

Autologous blood predonation in cardiac surgery

The risk of transfusion of allogeneic blood products on outcome is well documented. Autologous blood donation prior to elective cardiac surgery has repeatedly shown to be an effective practice to reduce the exposure to allogeneic blood, but was criticized because of the alleged high costs. We analyzed the data of 4878 patients undergoing elective open-heart surgery, in whom 18% underwent autologous donation. Overall, autologous blood donation reduced the incidence of allogeneic blood transfusion from 48 to 13% during hospitalization. Additionally, it is shown that diagnosis adjusted autologous blood donation is cost-effective. The higher the probability of transfusion the better is efficacy and cost-effectiveness of predonation. Cardiac surgery is a high-transfusion area, thus, it offers ideal conditions for autologous donation. Autologous blood donation still remains a promising and cost-effective alternative to reduce allogeneic blood transfusion in elective cardiac surgery.

Transfusion strategy for primary knee and hip arthroplasty: impact of an algorithm to lower transfusion rates and hospital costs

Blood transfusion strategies should reduce both blood transfusion and costs. Possible solutions include autologous donation for selected patients and the prescription of erythropoietin (EPO). We conducted a quality improvement program to examine the effect of a transfusion strategy algorithm in primary knee (TKA) and hip arthroplasty (THA). Our algorithm is presented as a diagram and is based on tolerated and expected blood losses. Patient characteristics, blood loss, transfusions given, autologous blood wastage, and costs were examined during an initial evaluation and after implementation of the algorithm. Analysis of 302 (initial evaluation) and 173 (post-implementation) arthroplasties demonstrated a 55% reduction in the prescription of autologous blood donation. The proportion of EPO prescriptions increased from 6.6% to 17.3% (P<0.05). There was a 56% overall reduction in transfusions to fewer autologous (32% vs 12%, P<0.0001) and allogeneic transfusions (21% vs 13%, NS). There were 50% fewer wasted autologous blood units (P=0.002) and a 50% reduction in hospital costs (euro345 vs 169) with no significant change in overall costs (euro439 vs 407). Anaesthetists applied the algorithm in 97% of patients, and it is still in use 1 yr after evaluation. In this study, the implementation of an algorithm for transfusion strategy changed practice and improved quality of care. The costs for EPO, its administration, and monitoring outside hospital were offset by the reduction in hospital transfusion costs.

Randomized Study of Aprotinin Effect on Transfusions and Blood Loss in Primary THA

A projected increase in total hip arthroplasties, shortfalls in blood availability, and awareness of complications of transfusion make blood management in orthopaedic surgery important. In a multicenter, randomized, double-blind, placebo-controlled study, we hypothesized use of aprotinin would reduce blood transfusions (any and allogeneic) and blood loss in total hip arthroplasty. Using an intent-to-treat approach, we recruited 393 patients stratified by preoperative autologous blood donation or none and then randomized them to receive aprotinin (176 patients receiving a 10,000 kallikrein inhibitor units [KIU] test dose, 2 million KIU load, 0.5 million KIU per hour) or placebo (177 patients). We assessed patients at baseline; postoperative days 1, 2, 3, and 7 (or discharge); and 6 +/- 2 weeks. Primary efficacy was percentage of patients having blood transfusion through day 7 or discharge. We based safety on reported adverse events. Aprotinin reduced transfusions by 46% (30 of 176 versus 56 of 177 patients). Aprotinin reduced the total number of any blood units and the number of allogeneic blood units transfused relative to placebo (48 versus 109 units and 30 versus 72 units, respectively). Serious complications were similar in the two groups (placebo, 11%; aprotinin, 10%). Our data suggest full-dose aprotinin is safe and effective in decreasing blood transfusion in total hip arthroplasty.

Erythropoietin in Patients Undergoing Elective Joint Arthroplasty and Preoperative Autologous Blood Donation

The aim of this study was to determine whether erythropoyetin (EPO) supplementation permits an adequate autologous blood donation prior to elective hip or knee arthroplasty in patients with boundary hematocrit and hemoglobin (Hb) levels. Between January 2000 and December 2001, sixty-six patients were included in this study who required total hip or knee arthroplasty and who had also been enrolled in a preoperative transfusion program. Patients were classified into two groups, taking into account their hemoglobin levels: those with Hb < 13 g/dl (group 1, 37 patients) received EPO (10.000 IU, 3 times a week) throughout the transfusion program whereas those with Hb > 13 g/dl (group 2, 29 patients) were not given EPO before or during the self-transfusion program. Blood was extracted from patients in both groups once a week for one to three weeks; all patients received oral iron supplementation. In all patients, median hemoglobin and hematocrit values were determined before the first blood extraction (baseline values), during the preoperative period and at discharge; a record was made of the amount of blood extracted and transfused for each group. Twenty patients were excluded during the study since they did not fulfill the inclusion criteria (group 1: n = 12; group 2: n = 8). Lastly, the data corresponding to 46 patients was statistically analyzed (group 1: n = 25; group 2: n = 21). Although the median baseline hemoglobin and hematocrit values for group 2 were significantly higher than those for group 1 (p < 0.001), no differences were observed between both groups regarding their median levels during the preoperative and postoperative periods or at discharge. Nor any differences were observed regarding the amount of blood extracted and transfused. Differences observed in the baseline hemoglobin and hematocrit levels between the two groups were fully resolved thanks to the prophylactic administration of EPO during the preoperative self-transfusion program, which was concluded appropriately even for patients with boundary hemoglobin and hematocrit levels. El objetivo de este estudio ha sido evaluar si la suplementación con eritropoyetina (EPO) permite una apropiada donación de sangre autóloga previa a una artroplastia electiva de cadera o rodilla, incluso en pacientes con niveles límite de hematocrito (Hcto) y hemoglobina (Hb). Desde enero de 2000 hasta diciembre de 2001 fueron incluidos en este estudio 66 pacientes que requirieron artroplastia total de cadera o rodilla, a quienes se había inscrito previamente en un programa de autotransfusión preoperatoria. Los pacientes fueron clasificados en dos grupos teniendo en cuenta sus niveles de Hb: aquéllos con un nivel de Hb < 13 g/dl (grupo 1; 37 pacientes) recibieron EPO (10.000 UI, 3 veces por semana) durante el programa de autotransfusiones, mientras que a aquéllos con un nivel de Hb > 13 g/dl (grupo 2; 29 pacientes) no se les suministró EPO ni antes ni durante el programa de autotransfusión. A los pacientes de ambos grupos se les extrajo sangre una vez por semana durante un período de entre una y tres semanas, administrándoseles además hierro por vía oral. En todos los pacientes se evaluaron los valores de Hb y Hcto antes de la primera extracción de sangre (valores basales), en el período prequirúrgico y al alta, registrándose además la cantidad de sangre recogida y transfundida para cada grupo. Durante el estudio se excluyeron 20 pacientes por no cumplir los criterios de inclusión (grupo 1, n = 12; grupo 2, n = 8). Finalmente, se analizaron estadísticamente los datos correspondientes a 46 pacientes (grupo 1, n = 25; grupo 2, n = 21). A pesar de que los valores basales de Hb y Hcto para el grupo 2 fueron significativamente más elevados que para el grupo 1 (p < 0,001), no se observaron diferencias entre ambos grupos en cuanto a sus niveles correspondientes durante el período preoperatorio, el postoperatorio y el momento del alta hospitalaria, ni tampoco en cuanto a la cantidad de sangre recogida y transfundida. La diferencia en los niveles basales de Hb y Hcto observada entre los dos grupos fue completamente corregida gracias a la administración profiláctica de EPO durante el programa de autotransfusión preoperatoria, el cual se desarrolló de forma adecuada incluso en aquellos pacientes con niveles límite de Hb y Hcto.

Guidelines for policies on alternatives to allogeneic blood transfusion. 1. Predeposit autologous blood donation and transfusion

SUMMARY This is the first of a series of newly prepared guidelines on alternatives to allogeneic blood transfusion. Further guidelines including the use of cell salvage and of pharmacological approaches to blood conservation will be published in due course. Decades of clinical application demonstrate that it is quite feasible to auto-transfuse blood that has been collected and stored for an interval of up to 6 weeks in standard storage media, and that up to three standard collection volumes (approximately 500 mL) can be collected from normal-sized adults (over 50 kg) during that interval. Furthermore, systems have been developed to reduce risk to participants and to boost haemoglobin (Hb) production during and after the procedure. However, such pre-operative autologous donations (PAD) are not without risk, are of low clinical efficacy and are poorly cost-effective for the vast majority of patients in the UK. These guidelines update those previously issued by the BCSH and do not recommend the practice and use of PAD unless the clinical circumstances are exceptional. They also give an update on the legal regulatory circumstances pertaining to the UK following recent European Directives.

BCSH guidelines for policies on alternatives to allogeneic blood transfusion. 1. Predeposit autologous blood donation and transfusion, August 2006 ‐ Reply from the Chairman of the BCSH Transfusion Task Force

Transfusion MedicineVolume 17, Issue 5 p. 366-366 BCSH guidelines for policies on alternatives to allogeneic blood transfusion. 1. Predeposit autologous blood donation and transfusion, August 2006 - Reply from the Chairman of the BCSH Transfusion Task Force F. Boulton, Corresponding Author F. Boulton National Blood Service, Southampton, UKFrank Boulton, British Committee for Standards in Haematology, 100 White Lion Street, London N1 9PF, UK.e-mail: frank.boulton@gmail.com, frank.boulton@nbs.nhs.ukSearch for more papers by this author F. Boulton, Corresponding Author F. Boulton National Blood Service, Southampton, UKFrank Boulton, British Committee for Standards in Haematology, 100 White Lion Street, London N1 9PF, UK.e-mail: frank.boulton@gmail.com, frank.boulton@nbs.nhs.ukSearch for more papers by this author First published: 27 September 2007 https://doi.org/10.1111/j.1365-3148.2007.00753.xCitations: 12Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume17, Issue5October 2007Pages 366-366 RelatedInformation

BCSH guidelines for policies on alternatives to allogeneic blood transfusion. 1. Predeposit autologous blood donation and transfusion, August 2006

BCSH guidelines for policies on alternatives to allogeneic blood transfusion. 1. Predeposit autologous blood donation and transfusion, August 2006

An audit on the current practice of red blood cell transfusion following elective primary hip arthroplasty

This audit encompassing a six-month period on the current practice of red blood cell transfusion following elective primary total hip arthroplasty showed that the rate of allogeneic blood avoidance was 84.8% for preoperative autologous blood donors and 47.8% for non-donors ( p < 0.001). Lower preoperative hemoglobin level was associated with an increased allogeneic unit transfusion ( p < 0.001). The intraoperative use of autologous blood collection and transfusion systems did not reduce the transfusion risk, and the use of the colloid volume expander was associated with a 1.8-fold increased risk of transfusion ( p = 0.022).

Autologous Versus Allogeneic Transfusions: No Difference in Perioperative Outcome After Partial Hepatectomy

Blood transfusion is often necessary in patients undergoing liver resection. Because of the risks associated with allogeneic blood products, preoperative autologous blood donation has been advocated, but its benefit with respect to perioperative outcome remains unclear. This study compares perioperative outcome in patients transfused only with autologous blood to a matched cohort receiving only allogeneic blood. All patients subjected to hepatic resection and given only perioperative autologous red cell transfusions were identified from a prospective database of 2,123 patients and reviewed retrospectively. This group was matched to patients transfused only with a comparable number of allogeneic red cell units and to a control group that received no blood products. All patients in the autologous or allogeneic group received either 1 or 2 U. Matching was based on age, comorbidity, extent of hepatic resection, and estimated blood loss. Matched pair analysis was performed using the paired t test, McNemar and Stuart–Maxwell tests. From December 1991 to May 2003, 124 patients undergoing hepatic resection received perioperative autologous blood only, for which optimal matching was possible in 104. The groups were similar with respect to age, comorbidities, and blood loss; the proportions receiving preoperative chemotherapy, requiring a major resection (≥3 segments) or a complex procedure (concomitant major procedure in addition to the principal hepatic resection) were also similar. There were no differences between the autologous and allogeneic groups in length of hospitalization, complications, and operative mortality. In patients undergoing hepatic resection, autologous blood transfusion did not demonstrably improve perioperative outcome when compared to a matched cohort of patients receiving a similar number of allogeneic units.

The cost‐effectiveness of autologous transfusion alternatives: an update and reappraisal

SUMMARYThere is still an ongoing debate whether autologous transfusion methods (ATM) are cost‐effective when compared with each other or with other medical interventions. A search on MEDLINE and in the British National Health Service Economic Evaluation Database was conducted to retrieve cost‐effectiveness analyses focusing on preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH) or perioperative blood salvage (PBS). The search covered the years from 1991 to 2006. The quality of retrieved papers was assessed using published criteria for the evaluation of economic analyses of health‐care measures. Twenty‐six studies were identified: ten for PABD, four for ANH, seven for PBS and five which evaluated strategies combining different ATM. Nineteen studies were conducted in the USA, including most of the PABD studies. Only one study included indirect costs in its cost estimates. The majority of analyses were based on suboptimal study designs. Only six studies employed randomized controlled trials, in most of which avoidance of allogeneic transfusion was chosen as the effectiveness parameter. Ten studies used decision analysis models, calculating cost‐effectiveness ratios based on quality‐adjusted life‐years. These included eight PABD studies and two PBS studies. The assumptions needed for the models were often either outdated or derived from unsystematic reviews of the pertinent literature. In conclusion, economic analyses of ATM are heterogeneous with respect to several aspects of study design. The currently available scientific evidence is of limited quality because of considerable uncertainties in estimates of several key variables thought to substantially affect the results of economic analyses.