Preoperative autologous brood donation - Efficacy, effectiveness, efficiency

Background: The diminishing risks of allogeneic transfusion such as substan tial reduction in transfusion-associated infections or prevention of immuno suppression and the recognition of limited financial resources for health c are measures cast doubt on the value of preoperative autologous blood donat ion (PABD) for public health. Material and Methods: The epidemiological con cept of efficacy, effectiveness, and efficiency has been applied to PABD. T he results of hitherto published studies are summarized and commented. Meas ures to further improve the cost-effectiveness of PABD are presented and ev aluated. They comprise limiting of serological screening or renunciation of component preparation of autologous units in appropriate cases. Results: W ith regard to the reduction of allogeneic transfusions, the efficacy of PAB D appears to be proven in colorectal cancer surgery, knee and hip arthropla sty, and liver resect ion. PABD is possibly efficacious in most other elect ive surgical interventions with significant, anticipated blood loss. PABD i s effective, i.e. it extends quality-adjusted life expectancy in these case s if there is no significant risk attributable to donation ora high statist ical or individual risk of allogeneic transfusion. PABD is probably efficie nt, i.e. cost-effective, in case of low patient age, low production costs o f the autologous deposit, high transfusion probability, and low donation ri sk. Conclusions: Published studies do not reflect the current situation. Th e safety of allogeneic blood has improved significantly, with regard to tra nsfusion-transmissible infections owing to intensified resting and with reg ard to immunosuppression owing to leukocyte depletion methods. On the other hand, not all feasible cost containment measures have been applied to PABD . Thus, the cost-effectiveness of PABD is still at issue. Further carefully controlled studies are needed.