The rise and fall of preoperative autologous blood donation

Volume 41, December 2001 TRANSFUSION 1459 www.transfusion.org Stimulated by the emergence of HIV as an infection transmissible by blood transfusion, interest in the use of autologous blood for transfusion soared in the 1980s and early 1990s1-8 (Fig. 1). In 1987, a national multicenter study estimated that as much as 10 percent of all RBC transfusions could be preoperatively donated by and transfused to patients undergoing elective surgery.8 Similarly, in 1995, a study of a community population in Olmsted County, MN, concluded that the total potential effect of preoperative autologous blood donation (PABD) on the blood supply could amount to a maximum of 9.7 percent of all transfused units of RBCs.9 Despite such predictions, nationwide, the percent of PABD has never approached 10 percent for either collection or transfusion. In fact, apparent interest in PABD peaked in 1992 (8.5% collected, 5.0% transfused) and has declined in recent years (4.7% collected, 3.0% transfused in 1999). It is interesting that academic interest, as reflected by the number of publications per year on autologous blood, has also followed a similar rise and fall pattern (Fig. 2). Why has there been this recent decline in interest in autologous blood? Have we failed, and should we be alarmed? Has it simply served its purpose? To answer these questions, it is important to briefly review what we have learned in recent years and how changes in transfusion medicine have affected the relevance of autologous blood use.