Preoperative autologous blood donation: a therapy that needs to be scientifically evaluated

The aim of preoperative autologous blood donation (PABD) is to reduce both the risk of transfusion transmitted disease and the need of blood from donors. One advantage of PABD is to prevent transfusion-transmitted disease namely viral infections such as HIV or hepatitis virus or emerging virus. Actually, the very low residual risk of allogeneic transfusion does not argue for PABD. On the other hand, the risk of bacterial contamination must be taken in account for both autologous and homologous transfusion (HT). A meta-analysis showed that ABD reduces the exposure to HT (OR: O.17). Clinical studies evidenced that patients who predonated autologous blood were more likely to receive any blood transfusions (autologous and/or allogeneic) than those who did not (OR: 3.31). More, the reduction of exposure to allogeneic transfusion may be questioned in view of prescription bias. Additionally, PABD is poorly cost-effective. It leads to significant blood wastage while in most studies about half of the units are discarded. In conclusion PABD is a therapy that has not been sufficiently evaluated. The interest of this therapy remains to be demonstrated.