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 (
Urology 1999;54:130–4
). Safety issues associated with autologous blood tx include tx reactions due to bacterial contamination during collection and storage (
Cleve Clin J Med 1996;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.

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