PREDEPOSIT OF AUTOLOGOUS BLOOD AND ISOVOL AEMIC HEMODILUTION - INDICATIONS AND PRACTICAL IMPLICATIONS

Objective: The state of the art of autologous blood transfusion is des cribed with special emphasis on safety aspects, indications and medico legal implications. Data Sources and Selection Criteria: Literature wa s retrieved using the MEDLINE literature database. Medical and legal e xpert opinions on autologous blood transfusion programmes are presente d as well as the actual German jurisdiction. Guidelines for autologous predeposit and haemodilution used in the University of Munster are de scribed. Results: In the past decade all forms of autologous transfusi ons gained increasing influence in haemotherapy due to the ongoing dis cussion on the safety of blood products. The German Federal Court has demanded that whenever homologous perioperative transfusion is conside red likely, patients have to be offered autologous predeposit. Legal c onditions for autologous programmes directed by anaesthetists not spec ialised in transfusion medicine are described. Whole-blood predeposit should be limited to two autologous units. In cases with minor blood l oss, isovolaemic haemodilution may be performed instead of autologous predeposit. However, autologous transfusions have their specific risks that are either related to the patient or to the procedure of autolog ous predeposit, e.g., clerical error, contamination of blood products and technical faults. Standard procedures of the University of Munster to ensure low-risk autologous transfusion are presented. They consist in adequate handling and proper identification, testing of donor for virus infection markers, bacterial culture from blood products and a l ist of contraindications: anaemia, unstable angina, myocardial infarct ion within 3 months, decompensated heart insufficiency, aortic valve s tenosis with angina, and cases with infection and fever. Conclusion: T he risks related with autologous transfusion should be lower compared to homologous transfusions. Well-defined standards concerning indicati ons and techniques are required to reach this goal.