What Is Autologous Blood Donation?

An autologous blood donation is when you have your blood drawn or collected before or during a scheduled surgery so that it can be returned back to you when you need it. When that happens, it is called an autologous blood transfusion.

Autologous blood donations are often recommended because they reduce the risk of you acquiring a bloodborne infection from someone else's donated blood and ensure that an ample supply of blood will be available for you if blood resources are scarce.

This article explains the types of autologous blood donations, when one may be recommended, the risks and benefits, and what to expect.

Types of Autologous Blood Donations

There are four types of autologous blood donation/transfusion procedures:

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

When This Might Be Done

Your doctor may recommend autologous blood donation/transfusion based on the type of surgery you are undergoing.

Other times, people concerned about blood transfusion risks may opt for this.

Recommended Use

Your surgeon may recommend an autologous blood donation ahead of time if there is a possibility that you will need a blood transfusion during or after surgery. Cell salvage transfusions can also be done in an emergency.

Autologous blood transfusions are generally considered when your doctor anticipates that you may lose 20% or more of your blood during surgery. In addition to major cancer surgeries, like the removal of part of the lung, autologous blood transfusions are often needed for major joint replacement surgeries, vascular surgeries, or cardiothoracic surgeries.

Sometimes as much as 10 units of packed red blood cells are needed—an amount equivalent to a person's entire blood volume. This is considered a massive transfusion when it occurs in a 24-hour period.

An autologous donation may also be suggested to relieve pressure on the community's blood supply. These donations can be used along with allogeneic donations (those from other people).

Elective Use

Autologous blood transfusions can reduce 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.

Your surgeon may bring up this possibility if your health history warrants it. The choice to proceed with an autologous donation/transfusion, however, is ultimately a personal one.

You can also request an autologous transfusion if you are worried about bloodborne infections like hepatitis C or HIV. However, strict blood screening protocols in the United States have made elective donations/transfusions for this purpose unnecessary and extremely rare.

If you're still concerned, donating and receiving your own blood can put your mind at ease.

Advantages and Disadvantages

There are both real and perceived benefits of an autologous blood donation and transfusion, but there are also risks.

Risks and Complications

There are some potentially serious complications associated with the different types of autologous blood donations/transfusions.

Donations Before Surgery

The risk of a preoperative autologous donation is no different than that of any other blood donation.

With that said, some medical conditions take the option of autologous blood donation off the table due to the risk of anemia.

Preoperative autologous donations are also not used in people with current heart disease and other conditions for which the donation may pose other risks. These include:

• Active seizure disorders
• Heart attack or stroke within six months
• Left-side coronary artery disease (high-grade)
• Sepsis or bacteremia
• Scheduled aortic aneurysm surgery
• Symptomatic heart failure
• Uncontrolled hypertension
• Unstable angina

Cell Salvage

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

This process can disturb the balance of electrolytes (chemical substances that conduct electricity) and reduce platelets (blood cells that control clotting).

These, combined with released hemoglobin (a protein in red blood cells), can trigger a serious condition called salvaged blood syndrome, in which clots form abnormally in blood vessels.

Salvaged blood syndrome can lead to severe lung injury and acute renal failure when the lungs or kidneys are involved.

Acute Normovolemic Hemodilution

With acute normovolemic hemodilution, the sudden reduction in the volume of red blood cells (hematocrit) may lead to circulatory shock.

This is when reduced blood flow damages body tissues. It can even cause a heart attack in people with underlying heart disease.

What to Expect

If you elect to undergo an autologous blood transfusion, a clinician will generally draw your blood ahead of your surgery.

There are no age or weight limits to an autologous transfusion. However, you should weigh the benefits and risks carefully before proceeding.

Screening

Not everyone is a good candidate for autologous blood donation, so your healthcare provider will help you determine if it is right for you. Some things they will consider include:

• Whether a transfusion is likely (for example, major orthopedic procedures, vascular surgery, or heart surgeries)
• If you are in good overall health
• If you have a rare blood type, where community supply may be low
• If you have an autoimmune disease that makes it more likely to have an adverse reaction to donated blood

The Process

The process of autologous donation is no different than regular blood donation, except your healthcare provider may prescribe an iron supplement prior to your donation to boost the production of red blood cells.

Autologous donations require a signed doctor's order and are done by appointment.

Upon arrival, a brief medical history is taken. In addition:

• A clinician will take your pulse, blood pressure, and temperature.
• They will perform a finger stick blood test to check your hematocrit and determine if you are anemic.
• If clinical signs are good, blood will be taken from a vein.
• Afterward, you'll eat a snack and rest for 10 to 15 minutes before going home.

Determining Donation Amount

Your surgeon determines the amount of blood you should donate based on your weight. The maximum donation is calculated at 10 milliliters per kilograms of body weight (mL/kg).

So, for example, a person who weighs 110 pounds (50 kg) can donate up to 500 milliliters (0.5 liters) per session.

Frequency

You can donate more than once a week, but the last donation should be made no less than 72 hours before your surgery. This allows time for your blood volume to return to normal.

Summary

Autologous blood donation may be done preoperatively so that you can receive your own blood if you require a transfusion during surgery. You may also do it electively if you want to avoid certain risks of blood transfusions, like bloodborne infections, allergies, or an autoimmune response.

Blood donations are generally considered safe. However, people with certain medical conditions are not good candidates for autologous blood donation. These include people with certain heart conditions and seizure disorders. Discuss the risks and benefits of an autologous blood transfusion with your surgeon.