Autologous transfusion and other approaches to reduce allogeneic blood exposure

When used as the sole source of transfused blood, the principal advantage o f autologous blood transfusion is the avoidance of transmission of infectio us agents and the avoidance of the purported adverse immunomodulatory effec ts of allogeneic transfusion. In the 1990s, however, the risks of transfusi on-transmitted diseases have been greatly reduced, and estimates of the cos t-effectiveness of pre-operative autologous blood donations now vary betwee n $2470 and $3 400 000 per quality-adjusted year of life saved, depending o n assumptions about the existence and magnitude of any adverse immunomodula tory effects of allogeneic transfusion. There is a paucity of randomized co ntrolled trials evaluating the clinical outcomes and the cost-effectiveness of autologous transfusion procedures, and this situation is unlikely to ch ange in the near future because of the difficulties in conducting such tria ls. This chapter reviews the available evidence on the efficacy, safety and cost-effectiveness of the three common autologous transfusion procedures. that is, pre-operative autologous blood donation, acute normovolaemic haemo dilution, and intra-operative and post-operative blood recovery.