Blood Donation Before Surgery

Should I donate my own blood before an operation?

When faced with major surgery, many people express concerns about the risks of blood transfusions. One way to sidestep this concern is with a preoperative autologous donation (PAD), in which blood is collected from a patient prior to surgery and reinfused back into the patient during or after surgery if needed.

Medical worker holding a bag of blood
Peter Dazeley / Getty Images

PAD is sometimes considered for major surgeries and can eliminate the risk of getting an infectious disease or experiencing a severe allergic or immunologic reaction from donated blood.

But, is such a procedure really necessary, and might the risks of an autologous transfusion outweigh the benefits?

Reasons for Autologous Transfusions

The reasons for a preoperative autologous donation can vary. In some cases, PAD is recommended for surgeries in which blood loss is expected to be high. At other times, PAD is used electively to avoid bloodborne infections and other risks, both real and perceived.

Surgical Indications

Blood loss is a common part of surgery, and while every effort is made to minimize the loss, there are certain surgeries in which this cannot be avoided.

When blood loss is anticipated to be greater than 20%, PAD may be recommended. This not only ensures an ample blood supply should a patient need it but also alleviates stress on the community blood supply.

Surgeries in which excessive blood loss is common include:

People who decide to pursue PAD will make the donation three to five weeks before their scheduled surgery. In the time between the donation and the surgery, the body can replenish much of the lost blood.

If less than 10% of blood is expected to be lost during surgery, an allogeneic blood transfusion (in which blood is donated from another person) is recommended.

Elective Use

Anticipated blood loss is only one of the reasons that PAD is used. Historically, autologous transfusions have been used as a means to avoid the transmission of bloodborne diseases.

The use of PAD was especially high in the early- to mid-1980s, when many people were reported to have been infected with HIV from blood transfusions. Many hepatitis C infections were also acquired from blood transfusions performed before the viral cause was officially identified in 1989.

PAD is also sometimes used in people with multiple autoimmune diseases in whom donated blood may trigger a hemolytic transfusion reaction, in which the immune system attacks and destroys transfused blood cells.

Safety

PAD is generally considered safe, with only mild short-term side effects, including minor bleeding, pain, bruising, fatigue, and lightheadedness.

With that said, PAD is typically avoided in people with certain pre-existing medical conditions in whom the loss of blood prior to surgery may have serious consequences. These include people with:

PAD is also avoided in people with known or suspected bacteremia (bacteria in the blood). Bacteria in the donated blood can proliferate as it awaits reinfusion, increasing the risk of septicemia (blood poisoning) and sepsis.

Risks of Disease Transmission

The perceived risk of a blood transfusion can often exceed the actual risk, particularly with regards to bloodborne infections. Despite fears of infection from HIV, hepatitis C, and other diseases, transfusions in the United States are considered safe and pose little risk of such transmission.

Since the advent of universal blood screenings in the late 1990s, the risk of acquiring HIV from blood transfusions has dropped to one in every 1.8 million procedures. In fact, from 1999 to 2003, only three people were confirmed to have gotten HIV from a blood transfusion in the United States.

Similarly, the risk of hepatitis C from contaminated blood is less than one in every two million procedures, according to a 2014 review of studies in the journal Transfusion.

Beyond the risk of infection, the chances of receiving incompatible blood (in which you are given the wrong blood type) are extremely rare in the United States and considered a "never event" in the United Kingdom.

A Word From Verywell

Although receiving your own blood may put your mind at ease, preoperative autologous transfusions are really only considered if there is a local blood shortage and/or your anticipated blood needs after surgery are high.

Even if you have multiple autoimmune syndrome, severe allergies, or a rare blood type, there are ways to minimize your risk from an allogeneic transfusion. There are also drugs like tranexamic acid (TXA) that surgeons use to significantly reduce blood loss following major orthopedic and cardiac surgeries.

If used for other purposes, PAD may not only be unnecessary but wasteful as the unused blood can only be stored for 42 days before it has to be disposed of.

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