Abstract
PAD effectively reduces exposure to allogeneic blood and its attendant risks in the surgical setting (
JBJS Am. 1999;81:2–10
). However, its use is declining as concerns regarding efficacy, safety, cost and convenience emerge (Crit Care. 2004;8(suppl2):S49–S52
). The objective of this paper is to review the evidence-based risk/benefit profile of PAD in the perisurgical setting. A MEDLINE search (1994-July 2004) was conducted using the following strategy: preoperative autologous blood donation; autologous blood donation; OR autologous blood transfusion AND (safety; adverse events; adverse effects; patient satisfaction; quality of life; cost OR pharmacoeconomics) NOT dialysis AND clinical trial AND English AND human [MeSH]. 130 unique references were evaluated; relevant references are discussed in this section. It is commonly acknowledged that PAD can reduce allogeneic transfusion (tx) rates in the perisurgical setting. Other benefits include: supplementation of the blood supply, provision of compatible blood for patients (pts) with alloantibodies, and prevention of disease transmission, RBC alloimmunization, and some adverse tx reactions (Crit Care. 2004;8(suppl2):S49–S52
). As a result, PAD may reduce hospital LOS (JBJS Br. 1997;79:630–632
). Both donation and tx of autologous blood are associated with unique risks. Donation causes a phlebotomy-induced anemia which may not stimulate erythropoiesis sufficiently to restore the donated blood (Orthopedics. 1999;22(suppl1):s105–12
; JBJS Am. 1998;80-A:750–762
; Arch Orthop Trauma Surg. 2001;121:162–5
; JBJS Am. 2004;86-A:1512–1518
; JBJS Am. 2003;85-A:2485–6
). Safety issues linked to donation include arterial hypotension in pts with cardiovascular disease (Transfusion. 2002;42:226–231
), precipitation of angina and cardiac arrest, and mild dizziness and light-headedness (Cleve Clin J Med. 1996;63:295–300
). Donation is time consuming and inconvenient, thus economically burdensome to patients and to healthcare providers who collect, process, and transfuse the blood (Clin Orthop. 2004;(423):240–4
). The total tx burden (autologous + allogeneic) may be increased in those who donate and receive their own blood (Orthopedics. 1999;22(suppl1):s105–12
). When autologous blood is available, a physician may have a low threshold to transfuse, with the result that autologous blood tx is often inappropriate in relation to cardiopulmonary risk (Urology 1999;54:130–4
). Safety issues associated with autologous blood tx include tx reactions due to bacterial contamination during collection and storage (Cleve Clin J Med 1996;63:295–300
, Crit Care. 2004;8(suppl2):S49–S52
) and increased concentrations of IL-6 and IL-8 in recipients (Anesthesiology. 1997;87:511–6
). Autologous blood tx carries many of the same risks as allogeneic: volume overload, ABO incompatibility due to administrative error (Crit Care. 2004;8(suppl2):S49–S52
) and reduced oxygen-carrying capacity as a result of the RBC storage lesion (Orthopedics. 2004;27(suppl6):s643–51
, Crit Care Med. 2004;8(suppl2):s24–s26
). Finally, inability to release unused autologous blood into the general blood pool because of inadequate screening causes a high rate of wastage, and renders PAD extremely cost inefficient (Urology. 1999;54:130–4
, J Clin Anesth. 1997;9:26–9
). PAD in the surgical setting should be used judiciously and cautiously, weighing all associated risks and benefits. Alternative management strategies warrant careful consideration.Author notes
Corresponding author
2005, The American Society of Hematology
2004
