Autologous versus allogeneic transfusion: patients' perceptions and experiences

Background: Preoperative autologous donation is one way to decrease a patie nt's exposure to allogeneic blood transfusion. This study was designed to d etermine patients' perceptions about the autologous blood donation process and their experiences with transfusion. Methods: To assess patient perception, a questionnaire was administered a f ew days before surgery to patients undergoing elective cardiac and orthoped ic surgery in a Canadian teaching hospital. All patients attending the preo perative autologous donation clinic during a 10-month period were eligible. A convenience sample of patients undergoing the same types of surgery who had not predonated blood were selected from preadmission clinics. Patient c harts were reviewed retrospectively to assess actual transfusion practice i n all cases. Results: A total of 80 patients underwent cardiac surgery (40 autologous do nors, 40 nondonors) and 73 underwent orthopedic surgery (38 autologous dono rs, 35 nondonors). Of the autologous donors, 75 (96%) attended all schedule d donation appointments, 73 (93%) said that they were "very likely" or "lik ely" to predonate again, and 75 (96%) said that they would recommend autolo gous donation to others. There was little difference in preoperative sympto ms between the autologous donors and the nondonors, although the former wer e more likely than the latter to report that their overall health had remai ned the same during the month before surgery (30 [75%] v. 21 [52%] for the cardiac surgery patients and 30 [79%] v. 18 [51%] for the orthopedic surger y patients). When the autologous donors were asked what they felt their cha nces would have been. of receiving at least one allogeneic blood transfusio n had they not predonated, the median response was 80%. When they were aske d what their chances were after predonating their own blood, the median res ponse was 0%. The autologous donors were significantly less likely to recei ve allogeneic blood transfusions (6 [15%] for cardiac surgery and 3 [8%] fo r orthopedic surgery) than were the nondonors (14 [35%] for cardiac surgery and 16 [46%] for orthopaedic surgery). They were, however, more likely to receive any transfusion (autologous or allo-geneic) than were the nondonors (25 [63%] v. 14 [35%] for cardiac surgery and 31 [81%] v. 16 [46%] for ort hopedic surgery). Interpretation: Patients who underwent preoperative autologous blood donati on were positive about the experience and did not report more symptoms than patients who did not donate blood preoperatively. Autologous donors overes timated their chances of receiving allogeneic blood transfusions had they n ot predonated and underestimated their chances after they had predonated. T hey were less likely to receive allogeneic transfusions, but more likely to receive any type of transfusion, than were patients who did not predonate.