[Preoperative donation of autologous blood and plasma]

The risk and side effects of homologous blood transfusion led to an increased interest in autologous transfusion concepts. Whereas peri- and intraoperative procedures are clinical methods, preoperative autologous blood donation belongs into the responsibility of a transfusion service in order to ensure qualified separation into blood components as well as correct storage and handling. Special knowledge in transfusion medicine is necessary for the application of preoperative autologous plasmapheresis. On the other hand, its use by clinicians under adequate controlled conditions seems to be rather safe. Although autologous transfusion includes the lowest risk, side reactions cannot be completely excluded. There is also a risk of secondary bacterial contamination. Side effects due to the specific composition of the various blood components, to alterations during storage and to the way of application have to be considered, too. Severe haemolytic transfusion reactions are mostly caused by exchange of blood samples, patients or blood units. They are to be expected in autologous blood transfusion as well. In addition, there is an increased risk of infection when autologous blood components are exchanged accidentally. There is only an indication for autologous blood if the total risk of autologous donation as well as transfusion in the individual case is lower than the statistical risk of homologous transfusion. Autologous blood donation should be offered to all patients undergoing elective surgery where blood is likely to be required and when blood donation is practicable. Preoperative autologous plasmapheresis is indicated in elective surgery if intra- and perioperative autotransfusion methods shall be used and a blood loss of at least 1.5 liters can be expected. There are a lot of organizational problems in autologous blood transfusion which can be solved by adequate information of all persons involved and close cooperation between clinicians and transfusion service. The high standard which was developed for homologous transfusion in the last 15 years has to be maintained for autologous blood transfusion, too.