[Benefits and risks of autologous blood donation]

Aim of this review is to compare benefits and risks of autologous blood transfusion with special emphasize on donation and retransfusion risks. Autologous blood transfusion may reduce the transfusion-associated mortality by 70%. Another advantage of preoperative autologous blood donation is the increase in erythropoiesis. Immunologic and viral infectious complications have not been reported with transfusion of autologous blood. On the other hand, autologous blood predonation is associated with risks during donation and retransfusion. Reactions due to routine autologous predonation of blood have been examined in several studies. Mild and moderate reactions occurred in similar frequencies with autologous predeposit and homologous donations, respectively. High risk autologous predonation has also been successfully performed in patients with end-stage heart or lung disease and in pregnancy. No data could be retrieved concerning the frequency of retransfusion-associated risks, e.g., clerical error or contamination of blood products. Bacterial contamination of autologous blood is published only in case reports. Autologous blood transfusion has minor impact on hospital mortality since overall risk of transfusion is low compared to mortality of anesthesia and surgery. However, no reliable criteria exist by which rare severe complications such as unstable angina or transient ischaemic attacks could be predicted. In cases with minor blood loss isovolaemic haemodilution should be performed instead of autologous predeposit. Autologous predonation should be done whenever other forms of autologous transfusion are not sufficient to exclude homologous transfusion.