Also called autotransfusion, autologous blood transfusion is the collection, filtration, and reinfusion of the patient’s own blood. Autologous transfusion is becoming increasingly common because of the declining rate of blood donation, the concerns related to the risks involved with allogenic blood transfusions, and the costs associated with blood transfusions.

Indications for autologous transfusion include elective surgery (blood is donated over time); perioperative and emergency blood salvage during and after thoracic or cardiovascular surgery and hip, knee, or liver resection and during surgery for ruptured ectopic pregnancy and hemothorax; and perioperative and emergency blood salvage for traumatic injury of the lungs, liver, chest wall, heart, pulmonary vessels, spleen, kidneys, inferior vena cava, and iliac, portal, or subclavian veins.

Autologous transfusion has several advantages over transfusion of bank blood. Transfusion reactions don’t occur, diseases
aren’t transmitted, anticoagulants aren’t added (except in postoperative autologous transfusion, when acid citrate dextrose is added), and the blood supply isn’t depleted. Also, unlike bank blood, autologous blood contains normal levels of 2 3-diphosphoglycerate, which is helpful in tissue oxygenation.

There are three techniques for autologous transfusion: preoperative blood donation, perioperative blood donation, and acute normovolemic hemodilution.¹ Preoperative collection is used when a patient is donating his own blood before a planned procedure. Perioperative blood donation (sometimes called intraoperative or postoperative), in which blood is collected during or after surgery, is used in vascular and orthopedic surgery and in the treatment of traumatic injury.

The third option, acute normovolemic hemodilution, is used mainly in open-heart surgery. It’s performed the same way as preoperative blood donation. One or two units of blood are collected immediately before or just after anesthesia induction. The blood volume is replaced with crystalloid or colloid solution to produce normovolemic anemia. The blood is then reinfused after surgery.

Autologous blood transfusion does have its drawbacks. With preoperative donation, one must consider that collected blood has an expiration date. If the procedure must be rescheduled, the patient may have to donate again. The donation process may also involve additional fees for the patient. Finally, not all patients may be candidates to donate the amount of blood that is needed. Contraindications include existing infections or known inflammatory disease, antibiotic use, long-term corticosteroids or nonsteroidal anti-inflammatory medication use, malignant neoplasms, coagulopathies, cardiovascular disease with compromised hemodynamic reserves, anemia, contamination of blood with bowel contents, malnutrition or excessive weight loss due to illness, use of antiplatelet agents in the weeks prior to surgery, and severe preexisting lung or renal dysfunction.