Autologous transfusion

doi:10.1136/bmj.324.7340.772

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Elizabeth S Vanderlinde, chief residenta,
Joanna M Heal, associate clinical professor of medicinec,
Neil Blumberg, director, transfusion medicine and blood bank (Neil_Blumberg@urmc.rochester.edu)b

^a Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Box 608, 601 Elmwood Avenue, Rochester, NY 14642, USA
^b Transfusion Medicine Unit, University of Rochester Medical Center
^c Department of Medicine, University of Rochester Medical Center

Correspondence to: N Blumberg

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.1 We describe the three main types of autologous transfusion and draw attention to the advantages and disadvantages of each technique (see table A on bmj.com). 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

Methods

We searched Index Medicus for publications on autologous transfusion. Many descriptive and methodological papers have described the efficacy of autologous transfusion in reducing allogeneic transfusion. Recent books and reviews address the technical and clinical aspects of the three types of autologous transfusion in detail.2^–4 It is accepted that these techniques reduce the use of allogeneic blood, but the quality of the evidence varies, and possible drawbacks, such as temporary anaemia, have not yet been studied thoroughly. 5 6

Autologous transfusion driven by concerns about the safety of blood

Transfusion is a ubiquitous and potent treatment underlying much of modern medical practice. Once an unquestioned adjunct to patient care, allogeneic transfusion is currently being re-evaluated, and alternatives to conventional practice are being considered …