3.6 Effect of perioperative strategies that minimise blood loss

3.6.1 Preoperative autologous donation

The detailed findings of the systematic review for this intervention can be found in Section 3.10.1 of Volume 1b of the technical report.4 The systematic review process identified nine Level I studies and two RCTs that assessed the effect of preoperative autologous donation (PAD) in patients undergoing surgery. There was substantial overlap between many of the systematic reviews. Therefore, two Cochrane reviews, both of good quality, were chosen as the basis of the evidence review.146,147

Transfusion requirements

In adult patients undergoing surgery in which substantial blood loss is anticipated, although PAD decreases the incidence of allogeneic RBC transfusion, it increases the overall incidence of RBC transfusion.147 The authors concluded that, ‘although the use of PAD provides the patient with a sense of wellbeing, knowing they will receive their own blood if needed, the process is not without its own risks’.

Haemoglobin concentration

Henry et al (2001) found that patients who underwent PAD had significantly lower preoperative haemoglobin concentration than patients who did not pre-donate blood.147 However, Bouchard et al (2008) found no significant difference in haemoglobin concentration between PAD patients and control, preoperatively or 5 days after surgery.148

EVIDENCE STATEMENTS – preoperative autologous donation	Evidence	Consistency	Clinical impact	Generalisability	Applicability
In adult patients undergoing surgery in which substantial blood loss is anticipated, PAD reduces the incidence of allogeneic blood transfusion.
In adult patients undergoing surgery in which substantial blood loss is anticipated, PAD increases the overall incidence of blood transfusion.
In adult patients undergoing surgery in which substantial blood loss is anticipated, PAD may reduce the volume of allogeneic blood transfusion.		NA
In adult patients undergoing surgery in which substantial blood loss is anticipated, PAD does not appear to have an effect on the overall volume of blood transfusion.		NA
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of PAD on blood loss is uncertain.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of PAD on mortality is uncertain.	X	NA	X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of PAD on morbidity is uncertain.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of PAD on quality of life is unknown.	NA	NA	NA	NA	NA
In adult patients undergoing surgery in which substantial blood loss is anticipated, PAD reduces preoperative haemoglobin concentration.
In adult patients undergoing surgery in which substantial blood loss is anticipated, PAD does not appear to have an effect on prothrombin time.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of PAD on length of hospital stay is uncertain.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of PAD on length of ICU stay is uncertain.		NA	X

ICU, intensive care unit; PAD, preoperative autologous donation; RBC, red blood cell

(See Table 2.2)

RECOMMENDATION – preoperative autologous donation

R11 Grade C	The routine use of PAD is not recommended because, although it reduces the risk of allogeneic RBC transfusion, it increases the risk of receiving any RBC transfusion (allogeneic and autologous) (Grade C).

PAD, preoperative autologous donation; RBC, red blood cell