ABC of transfusion. Autologous transfusion.
Authors: D Lee, J A Napier
Journal: BMJ (1990)

Aims and techniquesA much heralded alternative to the use of volunteer donations to replace blood lost during elective operations is the use of the patient's own blood.Autologous transfusion is primarily intended to avoid transmission of infection, in particular of HIV but also of the hepatitis viruses and other Aims of autologous transfusion: bloodborne pathogens.To be successful the autologous transfusion should * Reduce risks of transfusion ideally provide all the blood the patient needs.This benefit is reduced when * Conserve stocks of blood the transfusion must be supplemented by the use of blood from volunteer * Reduce work load in blood banks donors.In seeking to reduce the risks it is important to consider other ways in which the aims might be achieved.These include a greater readiness on the part of clinicians to rely on synthetic volume expanders or albumin to replace blood losses and the use of planned haemodilution during operations.Most blood transfusions entail giving no more than two or three units of blood to replace comparatively small losses in patients who are not anaemic.This type of transfusion is potentiafly avoidable, and a reduction in the numbers would offer by far the greatest chance of reducing the overall risks oftransfusion as well as relieving some of the pressure ofwork in blood banks, thereby increasing safety._ -_ Autologous transfusion is a generic term encompassing various technical procedures.Two main approaches are possible; blood is either collected and stored during the weeks before operation or, alternatively, blood lost from the operation site is recovered and processed for transfusion -a procedure known as "blood salvage."In addition, though they are not strictly autologous there are also "directed" donations, which are collections of blood from family or friends to meet anticipated needs.To patients this approach is superficially attractive; experience has shown, however, that such donations are rather less safe than those collected from volunteer donors using the current stringent criteria for selection of donors.Cell saver in use during an operation.Friends and relatives are under such strong pressure to donate blood that they may not mention contraindicating factors.The practice of using directed donations is not endorsed by blood transfusion services, apart from the possible exception when a mother's blood may be 'ised to transfuse her small infant. Risks of blood transfusionTo reduce risks:Like all other therapeutic interventions, blood transfusion has risks as .Deposit autologous blood beforehand well as benefits.Until the advent of AIDS and the observed link between the transmission of HIV and transfusion, blood transfusion using blood * Use haemodilution before and during collected from donors was regarded as a safe and reliable means ofinsurance operation in the event of massive operative blood loss.For a time after that, until the Use plasma expanders reliability of screening could be assessed, some people considered * Salvage blood during operation transfusion to be at best unsafe and at worst positively dangerous.