3.4.1 Autologous Transfusion

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    BMJ 2002;324:772-775 ( 30 March ) link to article

    Clinical review

    Autologous transfusion

  • Elizabeth S Vanderlinde, chief resident a,
  • Joanna M Heal, associate clinical professor of medicine c,
  • Neil Blumberg, director, transfusion medicine and blood bank b.
    •

    1. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Box 608, 601 Elmwood Avenue, Rochester, NY 14642, USA,
    2. Transfusion Medicine Unit, University of Rochester Medical Center,
    3. Department of Medicine, University of Rochester Medical Center
      4.

    Since the AIDS epidemic of the early 1980s the interest in alternatives to allogeneic transfusion has grown, particularly for elective surgery. One alternative that currently accounts for over 5% of the blood donated in the United States and some countries in Europe is autologous transfusion, obtained primarily by preoperative donation. Although autologous transfusion is used less widely in the United Kingdom than in the United States, guidelines on its use have recently been published in the United Kingdom. We describe the three main types of autologous transfusion and draw attention to the advantages and disadvantages of each technique. We also review the evidence from observational and controlled trials comparing autologous with allogeneic transfusion.

    Summary points:

  • Autologous transfusion reduces the need for allogeneic transfusion and is most widely used in elective surgery
  • Autologous transfusion is one of several techniques used to reduce the need for allogeneic transfusion
  • The three main techniques are predeposit transfusion, intraoperative haemodilution, and intraoperative and postoperative salvage
  • Evidence from clinical trials shows that autologous transfusion is more cost effective than allogeneic transfusion and that clinical outcomes are improved

    • The chart (below) illustrates "The degree of anxiety and concern about the safety of blood transfusion over the centuries"



    The table (right) shows that the techniques used to conserve blood and avoid allogeneic blood transfusion must be applied in combinations appropriate to the patient and the operating team:
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