For patients requiring longer term red cell transfusion support, clinicians should select the product designed to supply the physiological red cell requirement with maximum in vivo recovery and survival. This may reduce donor exposures and transfusion episodes. Toxic effects should be diminished as far as possible by leucodepletion where indicated. If benefits from minimizing toxicity by reduction of iron load and plasticizer leaching can be established, products should be modified accordingly. Specific information relating to red and white blood cell content and activity, platelet count and activity, coagulation factor content, plasma potassium and glucose content, and acid load for red cell units should be made available by the Blood Transfusion Service to clinicians using the product.
Autologous transfusion remains an area of uncertainty.
In this field, as in other aspects of blood transfusion, wide variations in practice are observed. While increasingly of interest to patients there is evidence that significant morbidity may be associated with pre-donation in cardiovascular patients, sufficient in some cases to cause the procedure to be terminated. Also, there is evidence of increased transfusion rates when pre-deposit red cells are available on the one hand, and of blood wastage on the other. These disadvantages are counterbalanced by elimination of the risks of viral infection and reduction in the need for donor blood transfusion. The costs of pre-deposit donation are greater than those of donor blood.