Reassessment of Autologous Blood Donation
During the past 15 to 20 years, the use of autologous blood donation rapidly expanded as a strategy to reduce both the fear and the risk of transmitting infectious diseases including HIV and hepatitis. However, with extensive donor screening and improved testing, the risk of a homologous blood transfusion has decreased. Other risks of adverse phlebotomy-associated events or adverse non-infectious adverse events during administration of autologous blood still exist. Most autologous blood components are used for elective surgery and nearly half of these products are discarded.

Under the direction of Daniel Ambruso, MD, associate medical director for Bonfils Blood Center, an investigation of the characteristics, motivations and beliefs of a cohort of autologous blood donors was undertaken. Conclusions from the analysis of survey data included:

• Autologous donors are familiar with blood donation. Many had previously donated one or more homologous blood components, had family members engaged in autologous donation and/or had received a previous transfusion
• Both patients and their physicians request autologous collection
• Donors have significant concerns about infectious risks and perceive autologous donation to provide lower risk to adverse non-infectious events. In fact, when asked if all infectious agents could be eliminated from blood products, 76 percent of study subjects would still prefer autologous donation
• Lower costs are anticipated for autologous blood products

Dr. Ambruso also conducted a survey of orthopedic surgeons' perceptions and practices around autologous blood donation. Results found included:

• Many physicians prescribe autologous blood because of concerns of infectious disease, because it's a standard of care or the patients request it
• Most physicians would be likely to bank their own blood for surgery
• 51 percent of physicians said it has been between one and five years since they had read anything about autologous blood

The data in these studies support the need for strategies to educate donors and their physicians about the risks, benefits and costs of autologous and homologous blood components. A grant proposal is being developed to address this issue.

"This is not about getting rid of autologous donation," Dr. Ambruso said, "Education about the risks and benefits will lead to more appropriate use of autologous blood and result in a decrease in both cost and adverse events."

For more information, contact Daniel Ambruso, MD, at 303.363.2240.

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