Critical Evaluation of Preoperative Autologous Donation (PAD) in Surgery.
Authors: Spitzer Andrew I. , Keating E. Michael 
Published: October 2019

Abstract
PAD effectively reduces exposure to allogeneic blood and its attendant risks in the surgical setting (JBJS Am.1999;81:2–10). However, its use is declining as concerns regarding efficacy, safety, cost and convenience emerge (Crit Care.2004;8(suppl2):S49–S52). The objective of this paper is to review the evidence-based risk/benefit profile of PAD in the perisurgical setting. A MEDLINE search (1994-July 2004) was conducted using the following strategy: preoperative autologous blood donation; autologous blood donation; OR autologous blood transfusion AND (safety; adverse events; adverse effects; patient satisfaction; quality of life; cost OR pharmacoeconomics) NOT dialysis AND clinical trial AND English AND human [MeSH]. 130 unique references were evaluated; relevant references are discussed in this section. It is commonly acknowledged that PAD can reduce allogeneic transfusion (tx) rates in the perisurgical setting. Other benefits include: supplementation of the blood supply, provision of compatible blood for patients (pts) with alloantibodies, and prevention of disease transmission, RBC alloimmunization, and some adverse tx reactions (Crit Care.2004;8(suppl2):S49–S52). As a result, PAD may reduce hospital LOS (JBJS Br.1997;79:630–632). Both donation and tx of autologous blood are associated with unique risks. Donation causes a phlebotomy-induced anemia which may not stimulate erythropoiesis sufficiently to restore the donated blood (Orthopedics.1999;22(suppl1):s105–12; JBJS Am.1998;80-A:750–762; Arch Orthop Trauma Surg.2001;121:162–5; JBJS Am.2004;86-A:1512–1518; JBJS Am.2003;85-A:2485–6). Safety issues linked to donation include arterial hypotension in pts with cardiovascular disease (Transfusion.2002;42:226–231), precipitation of angina and cardiac arrest, and mild dizziness and light-headedness (Cleve Clin J Med.1996;63:295–300). Donation is time consuming and inconvenient, thus economically burdensome to patients and to healthcare providers who collect, process, and transfuse the blood (Clin Orthop.2004;(423):240–4). The total tx burden (autologous + allogeneic) may be increased in those who donate and receive their own blood (Orthopedics.1999;22(suppl1):s105–12). When autologous blood is available, a physician may have a low threshold to transfuse, with the result that autologous blood tx is often inappropriate in relation to cardiopulmonary risk (Urology1999;54:130–4). Safety issues associated with autologous blood tx include tx reactions due to bacterial contamination during collection and storage (Cleve Clin J Med1996;63:295–300, Crit Care.2004;8(suppl2):S49–S52) and increased concentrations of IL-6 and IL-8 in recipients (Anesthesiology.1997;87:511–6). Autologous blood tx carries many of the same risks as allogeneic: volume overload, ABO incompatibility due to administrative error (Crit Care.2004;8(suppl2):S49–S52) and reduced oxygen-carrying capacity as a result of the RBC storage lesion (Orthopedics.2004;27(suppl6):s643–51, Crit Care Med.2004;8(suppl2):s24–s26). Finally, inability to release unused autologous blood into the general blood pool because of inadequate screening causes a high rate of wastage, and renders PAD extremely cost inefficient (Urology.1999;54:130–4, J Clin Anesth.1997;9:26–9). PAD in the surgical setting should be used judiciously and cautiously, weighing all associated risks and benefits. Alternative management strategies warrant careful consideration.