Directed blood procurement does not benefit patients who are enrolled in an autologous blood predeposit program

Designated or directed blood transfusion (DD) is a controversial practice; its merits are currently debated on the basis of implications for the national blood supply and on the "safety" of directed blood compared with homologous blood. An equally compelling issue for the merits of DD is whether this practice results in its putative effect: to avoid volunteer homologous blood exposure. To study this, the authors reviewed 112 consecutive patients (73 orthopedic) who predeposited autologous blood for elective surgery. This group was compared with 17 patients (all orthopedic) who predeposited autologous blood and also requested storage of designated blood. Seven of 17 patients with DD subsequently received homologous blood, compared with 11 of 112 patients without designated blood (NDD, P less than 0.01) and 3 of 35 NDD orthopedic patients asked to predonate three or more units of blood, P = 0.015. DD and NDD patients were no different when analyzed for age, sex, or units blood stored; admission, nadir, or discharge hematocrit; autologous blood transfused; days in hospital; or surgical blood loss. The authors conclude that patient requests for DD are unjustified for elective surgical patients who are eligible to donate autologous blood because DD as practiced in this setting does not avoid subsequent homologous blood exposure. Maximizing autologous blood procurement is the preferred alternative for avoiding homologous blood transfusion.