Preoperative Autologous Donation Research Articles

Appraisal of awareness of medical staff about preoperative patient blood management in Saudi Arabia: a questionnaire-based study

Patient blood management (PBM) is a comprehensive approach to optimizing the care of patients who might need a transfusion. It involves the use of evidence-based strategies to reduce or avoid the need for allogeneic blood transfusions while ensuring that patients receive safe and appropriate care. PBM includes strategies such as preoperative autologous donation, intraoperative cell salvage, and minimally invasive techniques to reduce bleeding. The purpose of this study is to assess the medical staff’s awareness of preoperative PBM in Saudi Arabia. Between April 2022 and July 2022, data was collected using a 10-minute online (Google Forms) self-administered, anonymous, researcherstructured questionnaire adapted from previous studies and translated into both English and Arabic. The questionnaire was divided into three sections. The first section contained sociodemographic data, while the second section was used to estimate physicians’ and nurses’ knowledge of preoperative PBM. Two questions in Part 3 of the questionnaire were used to assess doctors’ and nurses’ preoperative PBM attitudes and practices. The average relationship between patients’ blood management attitudes and levels of awareness. It was revealed that there was a positive attitude (P≤0.005) as well as a high level of awareness (P≤0.002). The effect of job, gender, or geographical distribution on PBM awareness, attitude, and practice was not significant. Despite the fact that the majority of participants have a positive attitude and good awareness of PBM, more efforts should be implemented to improve PBM awareness, which was linked to increased transfusion practices and lower product costs.

Effect of erythropoietin on perioperative blood transfusions in primary total hip arthroplasty: A systematic review

BackgroundPrimary total hip arthroplasty (THA) often requires blood transfusion. Transfusions are undesirable due to risks of infectious and noninfectious complications. This systematic review therefore studied the effectiveness of erythropoietin (EPO) in reducing allogeneic transfusion rate during THA. MethodsUsing the MESH terms “Erythropoietin” AND “Total Hip” with restrictions to ‘Randomized Controlled Trial’, ‘Clinical Trial’, ‘Humans’, and ‘English’, a literature search was performed in PubMed and CINAHL. Articles were scanned by both authors and retained for further review if eligibility was met according to the inclusion criteria defined by the PICOS (population, intervention, comparator, outcomes, study design) configuration. Risk of bias was assessed using the Cochrane risk of bias criteria. Data extracted include patient demographics, intervention versus comparator arm, outcomes, laboratory data, and individual study characteristics. The primary outcome of focus was rate or amount of allogeneic blood transfusions intra- or postoperatively. In 6/8 studies, data permitted calculations of absolute risk reduction (ARR) in transfusion rate (%) and number needed to treat (NNT) to evade transfusions. ResultsA total of 8 studies met all eligibility criteria and were retained for data extraction; risk of bias was low-moderate in 7/8 and high in 1/8. Allogeneic transfusion exposure was lowered by the intervention in 7/8 studies with ARR from 9.6% to 33.5% and NNT from 4 to 10. ConclusionsIn the blood conservation systems described, the addition of EPO was effective in reducing allogeneic transfusions. The studies included spanned a nearly 30-year period. Earlier studies incorporated preoperative autologous donation, a now outdated modality.

Central hepatectomy for hepatocellular carcinoma in a patient with anti-Gerbich antibody

BackgroundAnti-Gerbich (Ge) alloantibody against high-frequency erythrocyte antigen is extremely rare. Owing to incomplete evidence regarding the degree and severity of adverse events induced by hemolytic transfusion reactions, the transfusion management often remains cumbersome in these patients. We report an anti-Ge alloantibody positive patient with hepatocellular carcinoma (HCC) who underwent central hepatectomy (CH) without the need for an allogeneic blood transfusion.Case presentationA 76-year-old Japanese woman was diagnosed with HCC measuring 9.5 × 8.0 cm in segments 4, 5, and 8 of the liver. This patient with anti-Ge alloantibody had a history of two pregnancies without transfusion. CH was planned, and based on the suggestion from the multidisciplinary team meeting, preoperative autologous donation (PAD) and acute normovolemic hemodilution (ANH) were performed. CH was successfully performed by using CUSA and Thunderbeat® with Pringle maneuver and infra-hepatic inferior vena cava clamping without perioperative need for an allogeneic blood transfusion. She has been alive without recurrence after a follow-up period of 45 months.ConclusionTo our knowledge, this is the first case report of hepatectomy in a patient with anti-Ge alloantibody. A multidisciplinary team approach, PAD and ANH, and bloodless liver surgical techniques appear to be useful for major hepatectomy in patients with extremely rare blood type.

Prolonged operative time increases risk of blood loss and transfusion requirements in revision hip surgery.

Revision hip surgery is well documented to have a high association with substantial blood loss and the associated need for a blood transfusion. This exposes the patient to increased risk of transfusion reaction and blood borne infection. There are many strategies to minimize allogeneic transfusion rates in revision surgery such as pre-operative autologous donation, peri-operative tranexamic acid, thrombin sealants, normovolaemic haemodilution, intra-operative blood salvage and the use of post-operative autologous drains. We prospectively looked at 177 consecutive cases performed at one centre by a single surgical and anaesthetic team to identify which patient and operative factors were most significant in minimizing the requirement for an allogeneic blood transfusion. Our results identified the duration of surgery as being the only significant variable affecting the level of blood loss. We noted a 3% increase in the probability of massive blood loss (> 2000mls) for every minute of increased surgical time in our series. We conclude that measures to minimize the duration of surgery would be beneficial in reducing blood loss and the risks of requiring blood transfusions in revision hip surgery.

The Strategy of Autologous Transfusion in a Porcine Model of Cardiopulmonary Bypass

Objective: Preoperative autologous donation has been shown to be a highly effective measure in reducing homologous blood use during cardiac operations in human. However, there is no previous animal...

Intra-operative cell salvage in urological surgery: a systematic review and meta-analysis of comparative studies.

To evaluate systematically the safety and efficacy of intra-operative cell salvage (ICS) in urology. A search of Medline, Embase and Cochrane Library to August 2017 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible titles were comparative studies published in English that used ICS in urology. Primary outcomes were allogeneic transfusion rates (ATRs) and tumour recurrence. Secondary outcomes were complications and cost. Fourteen observational studies were identified, with a total of 4 536 patients. ICS was compared with no the blood conservation technique (seven studies), preoperative autologous donation (PAD; five studies) or both (two studies). Cohorts underwent open prostatectomy (11 studies), open cystectomy (two studies) or open partial nephrectomy (one study). Meta-analysis was possible only for ATRs within prostatectomy studies. In this setting, ICS reduced ATR compared with no the blood conservation technique (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.15-0.76) but not PAD (OR 0.76, 95% CI 0.39-1.31). In the non-prostatectomy setting, ATRs amongst patients who underwent ICS were significantly higher or similar in one and two studies, respectively. Tumour recurrence was found to be significantly less common (two studies), similar (eight studies) or not measured (four studies). All six studies reporting complications found no difference in their ICS cohorts. Regarding cost, one study from 1995 found ICS more expensive than PAD, while two more recent studies found ICS to be cheaper than no blood conservation technique. As a result of inter-study heterogeneity, meta-analyses were not possible for recurrence, complications or cost. Low-level evidence exists that, compared with other blood conservation techniques, ICS reduces ATR and cost while not affecting complications. It does not appear to increase tumour recurrence post-prostatectomy, although follow-up durations were short. Small study sizes and short follow-ups mean conclusions cannot be drawn with regard to recurrence after nephrectomy or cystectomy. Randomized trials with long-term follow-up evaluating ICS in urology are required.

Preoperative autologous blood collection before bone marrow harvests in haploidentical related donors: is it justified?

With the increasing safety of allogeneic blood supply and declining need for transfusion due to patient blood management, the practice of preoperative autologous donation (PAD) continues to decline. The practice gained popularity during the 1980s and 1990s with the emergence of transfusion-transmitted human immunodeficiency virus and hepatitis C. At the peak of this public concern, the National Marrow Donor Program recommended that marrow donors have 1 to 3 autologous units of blood collected before their marrow harvest to minimize the likelihood of allogeneic transfusion. After three decades, the practice remains prevalent in marrow donors. We aimed to study the efficacy of PAD in healthy marrow donors. PADs performed before marrow harvest in healthy donors at our center between January 2013 and July 2015 were reviewed. The utilization of autologous units and decrease in hemoglobin levels due to PAD and marrow harvest were studied. Similar practices were assessed in the rest of the United States through a brief survey. Of a total of 262 autologous units collected from 136 donors, 25.2% were wasted. Ninety-nine percent of the marrow donors received at least 1unit of blood irrespective of the need. PAD contributed to preoperative anemia, exposing three donors to allogeneic blood transfusion. The survey results showed a mixed response with some institutions continuing and others not practicing PAD. PADs are not justified in healthy marrow donors as they expose them to a risk of preoperative anemia and hence a greater risk of transfusion.

The Idea of Preoperative Autologous Blood for Postpartum Fatigue

Postpartum fatigue is not only a common complication after childbirth, but also an important factor in maternal postpartum recovery and breastfeeding. In recent years, there is a wide application of autologous blood transfusion (ABT) in the operation of obstetrics, gynecology, orthopedic surgery, rare blood group surgery and others. Obstetrics mainly use preoperative autologous donation (PAD), however, if indication of blood transfusion is not in accordance with the current blood specification, autologous blood transfusion should be contraindicated which not only causes blood waste but also limits PAD applications. Learning from the practical experience of athletes to use blood doping to reduce fatigue and improve athletic performance, as well as the theory of Chinese traditional medicine of blood and mental spirit, this review puts forward an idea of applying autologous blood transfusion for postpartum fatigue.

Making Tranexamic Acid the Standard of Care in Hip and Knee Arthroplasty: Commentary on an article by Brian Hallstrom, MD, et al.: "The Michigan Experience with Safety and Effectiveness of Tranexamic Acid Use in Hip and Knee Arthroplasty".

A theoretical drawback of the use of antifibrinolytics in total joint arthroplasty (TJA), and tranexamic acid (TXA) specifically, has been the concern regarding an increase in venous thromboembolism (VTE). This has probably been the single-most important factor affecting the slow uptake and usage of this drug, despite the large amount of published literature demonstrating efficacy and safety going back to the late 1990s1,2. A number of early studies were published mainly in the European anesthesia literature, and as a result, received little readership among North American orthopaedic surgeons. Over the next 10 years, numerous attempts to limit postoperative transfusions following TJA, such as preoperative administration of erythropoietin, preoperative autologous donation for postoperative transfusion, intraoperative blood salvage, and postoperative reinfusion, failed to result in a substantial decrease in the transfusion rate. In the mid 2000s, …

Balancing Thromboprophylaxis and Bleeding in Total Joint Arthroplasty: Impact of Eliminating Enoxaparin and Predonation and Implementing Pneumatic Compression and Tranexamic Acid

BackgroundVenous thromboembolic disease (VTED) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) poses substantial risk. Pharmacologic prophylaxis against VTED can cause bleeding, transfusion, and associated complications. The ActiveCare+SFT is a portable, intermittent pneumatic compression device (IPCD), providing equivalent VTED prophylaxis to pharmacologic agents without associated bleeding. Tranexamic acid (TXA) is an antifibrinolytic that reduces blood loss after THA and TKA. Our objective was to measure blood transfusion and VTED after eliminating enoxaparin, introducing an IPCD, eliminating autologous blood transfusion, and administering TXA during primary TKA and THA. MethodsFour consecutive cohorts of THA and TKA patients were studied. Group A, the historical control, received enoxaparin VTED prophylaxis. Group B received IPCD VTED prophylaxis. Group C received IPCD VTED prophylaxis along with TXA (1 g intravenous at incision and closure). Groups A, B, and C predonated 1 unit of autologous blood. Group D received IPCD VTED prophylaxis, TXA as above, but did not donate blood preoperatively. ResultsSeventeen of 50 patients (34%) in Group A, 7 of 47 (14.9%) patients in Group B, 4 of 43 (9.3%) patients in Group C, and 0 of 46 patients in Group D received transfusions. There were no major symptomatic VTED events. ConclusionUsing an IPCD and TXA and discontinuing enoxaparin and preoperative autologous blood donation eliminated blood transfusion in primary THA and TKA without any increase in VTED. Using an IPCD instead of enoxaparin, adding TXA, and eliminating preoperative autologous donation each had an incremental dose response effect. This protocol provides effective VTED prophylaxis equivalent to pharmacologic methods and eliminates transfusion risk in the primary THA and TKA population.

Preoperative Autologous Blood Collection for Bone Marrow Harvests: Is It Justified?

IntroductionPreoperative autologous donation prior to bone marrow harvest is commonly performed at our hospital. We usually collect 2 units of autologous blood from the bone marrow donors prior to the harvest procedure. In order to save an additional trip to the donor center, we sometimes collect double red cell by apheresis procedure. The decision for doing double red cell collection is based on the donor's hemoglobin and willingness to undergo the procedure. We reviewed all the autologous collections performed at our hospital based blood bank over a period of 2 ½ years. The utilization rate of autologous units, cost effectiveness and donor adverse events were evaluated.Methods:A computerized search was performed for all the autologous donations performed between January 2013 and July 2015. The charts of only the donors undergoing bone marrow harvest were reviewed. All other indications for preoperative autologous blood donation were excluded. The pre-donation hemoglobin (HB), time from donation to day of surgery, and any adverse events during autologous donation were recorded. The preoperative HB values (usually 1- 3 days before surgery) and the amount of marrow harvested were also noted. The utilization of the collected units was evaluated by reviewing all the units that were transfused and those that expired on shelf. The cost effectiveness of all the autologous collections was evaluated.Results:A total of 262 autologous units were collected from 137 donors in age range 9-72 years (M:F = 1.3:1). Double red cell collection by apheresis was performed on 49 of 137 (36 %) donors in one visit. The remaining 88 donors underwent autologous collection of 1 to 2 units of whole blood. Five donors donated more than 2 autologous units throughout this time period. Among the 49 double red cell donors, only 3 were females and remaining 46 were males. Among the whole blood donors, 56 were females and 32 were male. The mean baseline HB prior to autologous donations was 12.9 g/dL (range 11 to 15) in female donors and 15.2 (range 12.5 -17.8) in male donors. The average amount of marrow harvested was 1232 cc (range 480 - 2000 cc). The average fall in HB (measured as the difference between the baseline HB and the HB prior to surgery) was 2.07 (range 0 to 4.6). The HB loss resulting from the procedure was not available since most of the donors undergoing marrow harvest were transfused in the operating room at the end of the procedure. Out of the 102 units collected by double red cell apheresis, 39 units (38 %) expired on shelf. Among the 160 whole blood autologous units, 25 units (16 %) expired on shelf. The overall utilization rate of all the autologous units was 75.5%. The marrow harvest was either cancelled or rescheduled in 15 donors. Three donors received allogeneic blood post operatively in addition to the autologous unit. The pre harvest HB was 10 or above in 93% of the donors. All the donors tolerated the marrow harvest procedure well. No severe adverse events were noted during any of the autologous donations.Conclusion:The instituitional trigger for transfusing blood is 9.0 g/dL and 93% of our donors had a pre-operative HB above 10 g/dL. Hence we conclude that these healthy donors can easily undergo the marrow harvest procedure without requiring any transfusion. The pre-operative autologous donations are unnecessary, time and resource consuming, costly for the donor and can be detrimental to donor's health by potentially exposing them overall to any type of blood. DisclosuresNo relevant conflicts of interest to declare.

Preoperative Autologous Blood Donation: Waning Indications in an Era of Improved Blood Safety.

A downward trend in preoperative autologous donation (PAD) continues in Europe and the Americas, with many jurisdictions only funding medically necessary collections at present. This is the result of decreasing real and perceived residual risks of allogeneic transfusion-transmitted disease and the declining need for transfusion due to patient blood management, which have also led to escalating logistical and cost constraints for PAD programs. We outline collection trends in North America, Europe, and Latin America and review the benefits, risks, effectiveness, and safety of PAD. Important elements of informed consent follow from these points. Evidence-based medical criteria for PAD and autologous transfusion are discussed as are methods to optimize autologous collection timing to regenerate donated red cells. Recommendations for identification of patients whose risk-to-benefit ratio suggests substantial benefit compared with other autologous blood salvage and anemia management alternatives conclude the review.

Effect of Preoperative Autologous Blood Donation Coupled With Fluid Resuscitation on Transfusion Requirements Following Orthopedic Surgery

Background: Preoperative auto-blood donation has been shown to increase the likelihood of developing postoperative anemia following orthopedic surgery. This study was to assess the additive effect of intraoperative plus postoperative fluid resuscitation upon the relationship between preoperative donation and the frequency of postoperative transfusion. Methods: In this retrospective, single institution case-controlled study, hemoglobin levels, fluid administration, and incidence of transfusion were reviewed among 182 patients (91 donated blood preoperatively and 91 did not) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Results: Thirty-two (35.2%) donors and 18 (19.8%) non-donors received transfusion for adjusted risk of 2.817 (1.301 - 6.100) among donors versus non-donors. Donors are more affected by the hemodilution effects associated with fluid infusion and are transfused earlier and more frequently than non-donors. Conclusion: Preoperative autologous donation and fluid administration increase the risk for receiving postoperative transfusion. J Hematol. 2015;4(2):157-163 doi: http://dx.doi.org/10.14740/jh208w

Systematic review of interventions for minimizing perioperative blood transfusion for surgery for craniosynostosis.

Surgery for craniosynostosis is associated with the potential for significant blood loss. Multiple technologies have been introduced to reduce the volume of blood transfused. These are preoperative autologous donation; preoperative erythropoietin; intraoperative cell salvage (CS); acute normovolemic hemodilution; antifibrinolytic drugs such as tranexamic acid, ε-aminocaproic acid, and aprotinin; fibrin sealants or fibrin glue; and postoperative drain reinfusion. All comparative studies with a treatment group and a control group were considered. There was a range of different study types from randomized controlled trials to case series with historic controls. These were intervention versus no intervention or a comparison of 2 interventions. Studies were identified by searching Cochrane CENTRAL, MEDLINE, and EMBASE; manufacturer's Web sites; and bibliographies of relevant published articles. The primary outcome measures were the number of allogeneic blood donor exposures, the volume of allogeneic blood transfused, and the postoperative hemoglobin or hematocrit levels. A total of 696 studies were identified. After removal of duplicates and after exclusion criteria were applied, there were 18 studies to be included. Fourteen were case series with controls and 4 were randomized controlled trials. The production of high-quality evidence on the interventions to minimize blood loss and transfusion in children undergoing surgery for craniosynostosis is difficult. Most of the literature is nonrandomized and noncomparative. Several areas remain unaddressed. Erythropoietin and tranexamic acid are comparatively well studied; CS, acute normovolemic hemodilution, and aprotinin are less so. There is only 1 comparative study on the use of fibrin glue and drain reinfusion, with no studies on preoperative autologous donation and [Latin Small Letter Open E]-aminocaproic acid. Tranexamic acid is clinically effective in reducing allogeneic blood transfusion. There is some evidence that CS and erythropoietin may be clinically effective. None of the interventions studied are shown to be cost-effective because of lack of evidence.

Blood management strategies in lower limb arthroplasty

Abstract Rates of post-operative allogenic blood transfusion in primary hip and knee arthroplasty can be as high as 50%. Risks of allogenic blood transfusion include increased risk of orthopaedic and non-orthopaedic infection in addition to the general risks of transfusion. Measures have been developed to minimise the requirements for post-operative allogenic blood transfusion in lower limb arthroplasty. These include pre-operative screening of patients, risk stratification, raising pre-operative haemoglobin pharmacologically, pre-operative autologous donation, minimising intra- and post-operative blood loss and suitable post-operative transfusion practices. Pharmacological, haematological and surgical methods of blood management in lower limb arthroplasty are discussed.

Intraoperative red cell salvage during obstetric surgery in 50 Japanese women

ObjectiveTo determine the clinical usefulness of intraoperative cell salvage (ICS) in obstetrics. MethodsA retrospective analysis was performed using data for 50 patients who had received ICS blood during obstetric surgery at 13 Japanese facilities between January 1, 2007 and December 31, 2013. The frequencies of ICS-associated adverse events, allogeneic blood transfusion (ABT), and preoperative autologous donation (PAD) were assessed. ResultsPlacenta previa was the indication for ICS in 42 (84%) women. The ICS blood was reinfused in all women (median 366mL; range 80 to at least 3715). No ICS-associated adverse events occurred. The median estimated blood loss (EBL) was 2171mL (range 574–47 000); 27 (54%) women lost at least 2000mL. ABT was not used in 33 (66%) women. Among 26 women who lost at least 2000mL of blood and were included in analyses, 12 (44%) did not receive ABT. EBL was linearly correlated with the total volume of transfused blood (P<0.001). ConclusionICS caused no adverse events among women at elevated risk of peripartum hemorrhage and might be safe for use in obstetrics.

Blood conservation in neurosurgery: erythropoietin and autologous donation.

Neurosurgery may involve significant blood loss and frequently requires allogeneic red blood cell (RBC) transfusion. Preoperative recombinant erythropoietin (EPO) may be used to improve erythroid status and recovery, and used either alone or in combination with preoperative autologous donation (PAD) it may reduce exposure to allogeneic RBC. We wished to study the use of EPO with and without PAD and the risk of RBC transfusion in neurosurgery. Using a retrospective case-control design, 57 patients who received EPO preoperatively were matched 2:1 for age, sex, year of surgery, and International Classification of Diseases code most responsible for surgery (three were excluded because of stringent matching criteria, leaving 54 cases and 108 comparison subjects). Thirty-two cases participated in PAD. Medical and anesthetic records as well as laboratory investigations were reviewed and extracted. Allogeneic RBC exposure was identical for EPO cases and comparison subjects (18.5%). Concomitant PAD and EPO did not reduce allogeneic RBC exposure (21.9%), and resulted in a greater number of RBC units transfused. Last recorded hemoglobin levels suggested that autologous RBCs were not more liberally used. Patients who engaged in PAD and EPO suffered from iatrogenic anemia. A significant proportion (58.6%) of the autologous RBCs was ultimately not used and discarded. Further research is needed to determine the efficacy of EPO in neurological surgery. PAD does not appear to reduce the risk of allogeneic RBC transfusion, despite concomitant EPO. Indeed, PAD resulted in iatrogenic anemia and increased transfusion requirements. The cost-effectiveness of blood conservation efforts in neurosurgery deserves additional research.

Blood Conservation

Blood Conservation

Potential Cost Saving of Epoetin alfa in Elective Hip or Knee Surgery due to Reduction in Blood Transfusions and Their Side Effects: A Discrete-Event Simulation Model

ObjectivesTransfusion of allogeneic blood is still common in orthopedic surgery. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa (EPO) compared to predonated autologous blood transfusions or to a nobloodconservationstrategy (allogeneic blood transfusion strategy)during elective hip and knee replacement surgery.MethodsIndividual patients (N = 50,000) were simulated based on data from controlled trials, the German DRG institute (InEK) and various publications and entered into a stochastic model (Monte-Carlo) of three treatment arms: EPO, preoperative autologous donation and nobloodconservationstrategy. All three strategies lead to a different risk for an allogeneic blood transfusion. The model focused on the costs and events of the three different procedures. The costs were obtained from clinical trial databases, the German DRG system, patient records and medical publications: transfusion (allogeneic red blood cells: €320/unit and autologous red blood cells: €250/unit), pneumonia treatment (€5,000), and length of stay (€300/day). Probabilistic sensitivity analyses were performed to determine which factors had an influence on the model's clinical and cost outcomes.ResultsAt acquisition costs of €200/40,000 IU EPO is cost saving compared to autologous blood donation, and cost-effective compared to a nobloodconservationstrategy. The results were most sensitive to the cost of EPO, blood units and hospital days.ConclusionsEPO might become an attractive blood conservation strategy for anemic patients at reasonable costs due to the reduction in allogeneic blood transfusions, in the modeled incidence of transfusion-associated pneumonia andthe prolongedlength of stay.

Targeted Preoperative Autologous Blood Donation in Total Knee Arthroplasty Reduces the Need for Postoperative Transfusion

BackgroundPreoperative donation of autologous blood has been widely used to minimize the potential risk of allogeneic transfusions in total knee arthroplasty. A previous study from our center revealed that preoperative autologous donation reduces the allogeneic blood exposure for anemic patients but has no effect for non-anemic patients.Questions/PurposesThe current study investigates the impact of a targeted blood donation protocol on overall transfusion rates and the incidence of allogeneic blood transfusions.MethodsProspectively, 372 patients undergoing 425 unilateral primary knee replacements were preoperatively screened by the Blood Preservation Center between 2009 and 2012. Anemic patients with a hemoglobin level less than 13.5 g/dL were advised to donate blood, while non-anemic patients did not donate.ResultsNon-anemic patients who did not donate blood required allogeneic blood transfusions in 5.9% of the patients. The overall rate of allogeneic transfusion was significantly lower for anemic patients who donated autologous blood (group A, 9%) than those who did not donate (group B, 33%; p < 0.001). Donating autologous blood did increase the overall transfusion rate of anemic patients to 0.84 per patient in group A compared to 0.41 per patient in group B (p < 0.001).ConclusionThis investigation confirms that abandoning preoperative autologous blood donation for non-anemic patients does not increase allogeneic blood transfusion rates but significantly lowers overall transfusion rates.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-013-9346-8) contains supplementary material, which is available to authorized users.