Preoperative autologous blood donation

SUMMARY Blood-conservation techniques are declining because of the increasingly safe allogeneic blood supply. However, they continue to be used because of the public’s perception of allogeneic blood risks and increasing blood shortage. Preoperative autologous blood donation (PABD) may decrease the risk of postoperative infection, either because immunomodulation is avoided, or because bacterial or viral infections have to be carefully screened before inclusion of a patient in a PABD program. However, the higher risk of mortality from allogeneic blood transfusion is now more likely due to administrative errors and to blood-transmitted infection, and the risks associated with banked autologous blood units are similar to those associated with banked allogeneic blood units. Therefore, when PABD is performed inducing anemia, there is an increase of the number of transfused units, thus an increase of the risk related to any transfusion. PABD is most beneficial in procedures that cause significant blood loss, in association with recombinant human erythropoietin administration and blood salvage. Identification of surgical candidates who will need transfusion and will therefore truly benefit from blood conservation must be based on factors specific to the patient, such as the baseline hematocrit and the anticipated blood loss during surgery. Professor Francesco Mercuriali promoted and validated this concept. The appropriate use of autologous techniques should be targeted toward the best possible costeffectiveness ratio for an individual patient. Despite its reduced role and declining rationale, PABD must be periodically revisited to assess its role in a changing environment.