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[Do we need autologous blood donation?].

J-F Schved1

  • 1EFS Pyrénées Méditerranée, site de Montpellier, 240, avenue Emile-Jeanbrau, 34094 Montpellier cedex 5, France. schvedjf@aol.com

Annales Francaises D'Anesthesie Et De Reanimation
|May 26, 2004
PubMed
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Preoperative autologous blood donation (ABD) may not reduce the need for donor blood transfusions and carries risks. Its cost-effectiveness and overall benefit require further evaluation.

Area of Science:

  • Transfusion Medicine
  • Surgical Safety

Background:

  • Preoperative autologous blood donation (ABD) was introduced to minimize transfusion risks and reliance on donor blood.
  • Surgical practices and patient selection criteria have evolved, necessitating a re-evaluation of ABD's utility.

Purpose of the Study:

  • To critically assess the current benefits and drawbacks of preoperative autologous blood donation (ABD).
  • To evaluate the effectiveness of ABD in reducing transfusion-transmitted diseases and the need for allogeneic blood.

Main Methods:

  • Review of theoretical advantages and existing clinical evidence regarding ABD.
  • Meta-analysis of studies comparing transfusion rates in patients undergoing ABD versus those who do not.
  • Consideration of risks, cost-effectiveness, and blood wastage associated with ABD.

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Main Results:

  • While ABD theoretically reduces exposure to transfusion-transmitted diseases, the residual risk from allogeneic transfusions is very low.
  • Meta-analysis indicates ABD reduces homologous transfusion exposure (OR: 0.17), but clinical studies show patients donating autologous blood are more likely to receive any transfusion (OR: 3.31).
  • ABD is associated with significant blood wastage and poor cost-effectiveness, with approximately half of donated units being discarded.

Conclusions:

  • The actual benefit of preoperative autologous blood donation (ABD) in reducing allogeneic transfusion exposure is questionable due to potential prescription bias.
  • The risk of bacterial contamination is a concern for both autologous and homologous transfusions.
  • The overall clinical value and cost-effectiveness of ABD remain insufficiently demonstrated and require further investigation.