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Chapter 48 - Autologous Transfusion

Lawrence T. Goodnough

Terri G. Monk

Autologous transfusion is not a new concept. Reinfusion of shed blood was employed as early as 1818,^[1] and preoperative donation of autologous blood was advocated in the 1930s, when the first blood banks were established.^[2] Several factors are responsible for the current popularity of autologous transfusion. The introduction of complex operative procedures, such as cardiac surgery and organ transplantation, stimulated the search for alternatives to allogeneic transfusion. Technological advances made possible the development of safe, easy-to-use devices for recovery and reinfusion of shed blood, and concerns regarding transfusion-transmitted disease stimulated growth of autologous programs.

There are three types of autologous blood transfusion: preoperative autologous donation (PAD), acute normovolemic hemodilution (ANH), and intraoperative and post-operative blood recovery (blood salvage). The advantages and disadvantages, applications, and complications vary with the techniques being used. It is often appropriate to employ more than one technique for patients undergoing surgical procedures associated with significant blood loss.

The two primary reasons for employing autologous transfusion are (1) avoidance of complications associated with allogeneic transfusion and (2) conservation of blood resources. Patients with rare blood phenotypes or alloantibodies can benefit from autologous transfusion because compatible allogeneic blood may not always be available.^[3] Potential complications of allogeneic transfusion that can be eliminated or minimized when autologous blood is administered include acute and delayed hemolytic reactions, alloimmunization, allergic and febrile reactions, and transfusion-transmitted infectious diseases. Intraoperative blood recovery may be the only option for providing a sufficient volume of compatible blood when severe, rapid blood loss occurs. ANH provides the only practical source of fresh whole blood.

The role of autologous blood procurement in surgery remains in evolution, based on improved blood safety, increased blood costs, and emerging pharmacologic alternatives to blood transfusion.^{[4] [5] [6]} Preoperative autologous donation (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.^[7] Subsequently, substantial improvements in blood safety have been accompanied by a decline in PAD ( Table 48-1 ) as well as an interest in acute normovolemic hemodilution (ANH) as an alternative, lower cost strategy.^[8] Nevertheless, public perception of blood safety and the reluctance to accept allogeneic blood transfusion in the elective transfusion setting,^[9] along with emerging blood inventory shortages, continue to give autologous blood procurement strategies an important role in the surgical arena.

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