[Perioperative salvage and use of autologous blood]

Pre-operative blood donation gives ready availability of large volumes of patient compatible blood, up to four units and five when erythropoietin is used. It is recommended that autologous pre-donated blood is leucocyte depleted immediately after the donation. During normovolaemic haemodilution it is mandatory to monitor haemodynamics during the donation. Usually 1-2 units are removed pre-operatively and returned during or after the operation. Intra and postoperative salvage and recycling is performed either with washing and haemoconcentration of the blood or with salvage and immediate retransfusion. When salvaged blood is retransfused unwashed there are high levels of free haemoglobin, degradation products of fibrin/fibrinogen, interleukin-6 and activated complement. Clinically, this has not been shown to be of importance. Taking the patient's health status into account, we suggest that a level of B-haemoglobin should be determined pre-operatively to indicate use of transfusions both with autologous and allogeneic blood.