Autologous Blood Donation for Surgery

Benefits and Risks You Need to Consider

Blood donation

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In This Article

An autologous blood donation is one in which a person donates blood for their own use prior to or during a scheduled surgery. When the blood is given back, it is called an autologous blood transfusion. This is in contrast to an allogeneic blood transfusion, in which blood from another from a person is used.

The primary reasons for an autologous transfusion are to reduce the risk of acquiring a bloodborne infection or to ensure an ample supply of blood for yourself if blood resources are scarce.

Types

There are four types of autologous blood transfusion procedures, each of which has its advantages and disadvantages:

  • Preoperative autologous donation (PAD) is a procedure in which blood is collected weeks in advance of the surgery, stored in a blood bank, and transfused back into the donor when needed.
  • Acute normovolemic hemodilution (ANH) involves the removal of blood right after anesthesia is given for surgery. To maintain normal blood volumes and blood pressure, the same amount of replacement fluid is transfused into the body.
  • Intraoperative cell salvage is a technique in which blood lost during the surgery is immediately returned into circulation using a machine called a cell saver. The machine not only filters the blood of debris but adds an anticoagulant to keep it from clotting.
  • Postoperative cell salvage involves the collection of lost blood during surgery via wound drains. The blood is treated in the same way as an intraoperative cell salvage but is reinfused after the surgery rather than during.

Indications

Autologous blood transfusions may either be recommended based on the type of surgery you are undergoing or an elective procedure used in people concerned about bloodborne infections, allergy, or an autoimmune response.

Recommended Use

If there is a possibility that you will need a blood transfusion during or after surgery, your surgeon may recommend an autologous blood donation prior to surgery. Cell salvage transfusions can also be done in an emergency situation.

This is especially true for surgeries in which blood loss can be massive, such as the resection of a lung or liver in people with cancer. In cases like these, it is not uncommon for a person to need as much as 10 units of packed red blood cells. An autologous donation can be used in addition to allogeneic donations to relieve pressure on the community blood supply.

Autologous blood transfusions are generally considered when it is anticipated that 20% or more of a person's blood may be lost during surgery. In addition to major cancer surgeries, autologous blood transfusions are often needed for major joint replacement surgeries, vascular surgeries, or cardiothoracic surgeries.

Preoperative autologous donations are generally avoided if less than 10% of blood is expected to be lost during surgery.

Elective Use

Autologous transfusions may also be used as an elective procedure for people who are concerned about getting a bloodborne infection like hepatitis C or HIV. Although transmission by this means is extremely rare in the United States due to blood screening protocols, donating and receiving your own blood eliminates the risk entirely.

Autologous blood transfusions can also mitigate the risk of an allergic or autoimmune response that can occur on rare occasions with allogeneic transfusions. This includes hemolytic transfusion reactions in which the immune system attacks and destroys donated blood cells.

Advantages and Disadvantages

Despite the benefits of an autologous blood transfusion, both real and perceived, they are not without their risks. From a larger perspective, there are pros and cons to undergoing the procedure.

Advantages
  • Reduced risk of bloodborne infections

  • Reduced risk of allergic or hemolytic transfusion reaction

  • Safer in people with rare blood types

  • Safer in people with multiple autoimmune disorders

  • Reduces the demands on the community blood supply

  • May be acceptable to Jehovah's Witnesses and other religious orders

Disadvantages
  • More costly than an allogeneic blood transfusion

  • Risk of an unnecessary blood transfusion

  • Unused blood is wasted

  • Risk of anemia and cardiac complications following the donation

  • Risk of bacterial infection due to improper storage of blood

  • May increase the need for a transfusion due to the depletion of blood from the body

Risks and Complications

There are a number of potentially serious complications associated with the different types of autologous blood transfusions.

Preoperative Donations

The risk of a preoperative autologous donation is no different than that of any other blood donation. With that said, because you are undergoing surgery, there are medical conditions for which a blood donation is not only inappropriate but downright dangerous.

Preoperative autologous donations are contraindicated for use in people with current heart disease and other conditions for which the transfusion may pose risks, including:

Preoperative autologous donations from pregnant women are also not recommended unless the benefits outweigh the risks, such as in the event of placenta previa or other conditions that place a woman at risk of postpartum hemorrhage.

Cell Salvage

With intraoperative or postoperative cell salvage, the retrieved blood can undergo significant changes as it is washed in preparation for the reinfusion.

The imbalance of electrolytes, loss of platelets, and release of hemoglobin from red blood cells can trigger a serious condition called salvaged blood syndrome, in which clots form abnormally in blood vessels. When the lungs or kidneys are involved, salvaged blood syndrome can lead to severe lung injury and acute renal failure.

Acute Normovolemic Hemodilution

With acute normovolemic hemodilution, the sudden reduction in the volume of red blood cells (referred to as hematocrit) may lead to circulatory shock and even a heart attack in people with underlying heart disease.

Currently, the effectiveness of acute normovolemic hemodilution compared to other types of autologous transfusions is uncertain, although it is considered safe if hematocrit levels of 30% or more are maintained.

What to Expect

If you elect to undergo an autologous blood transfusion, it will generally be done preoperatively. There are no age or weight limits to an autologous transfusion, although risks need to be weighed individually to ensure that you are a candidate for the procedure.

Upon arrival, a brief medical history is taken, as well as pulse, blood pressure, and temperature reading. A fingerstick blood test is then performed to check your hematocrit and determine if you are anemic.

The amount you are allowed to donate is based on your weight, with a maximum donation calculated at 10 milliliters per kilograms of body weight (mL/kg). A person who weight 110 pounds (50 kg), for instance, can donate up to 500 milliliters (0.5 liters) per session.

Donations can be performed more than once a week, but the last should occur not less than 72 hours before your surgery to allow time for your blood volume to return to normal.

Blood can be refrigerated for no more than 42 days, after which it is disposed of. Blood can be frozen, but it is not advised for autologous donations as it can damage blood cells and alter the composition of the blood.

A Word From Verywell

It is important to discuss the risks and benefits of an autologous blood transfusion with your surgeon, particularly if it is used to assuage your fears of getting a bloodborne infection. In some cases, the risks to your health may outweigh the perceived benefits.

It is also important to consider the cost of an autologous transfusion and to confirm that your insurance will cover the cost of the procedure. If your insurance company does not consider it necessary, they may deny your claim.

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