Practical aspects of preoperative autologous transfusion

Autologous transfusion, which is widely endorsed as the safest transfusion practice, has undergone rapid-and often unchecked-growth since the mid-1980s, primarily in response to the recognition of transfusion-associated HIV. Substantial improvements in blood transfusion safety, combined with the increasing emergence of managed care during the past decade, have spurred a reexamination of autologous transfusion and its ability to provide increased transfusion safety in a cost-effective manner. The ultimate utility of preoperative autologous donation and transfusion depends on whether (1) waste is limited by the development of meticulously crafted benchmarks for appropriate surgical applications, (2) donor-patient risk is limited by careful donor selection and scheduling and scrupulous attention to iron supplementation, (3) strategies are identified to enhance cost-effectiveness, and (4) policies and procedures are developed to reduce or prevent accidents and errors.