Effectiveness of and limitations to autologous blood transfusion therapy in major general surgery

Starting from the premise that the use homologous blood carries the risk of transfusion errors and transmission of infectious diseases, the authors report the results of a study on 135 candidates for major surgery who required an estimated 2 to 3 blood units and met the criteria for autotransfusion. After analysis of various blood collection methods (predonation, hemodilution, acute normovolemia, peri- and postoperative salvage and the preoperative use of erythropoietin), the authors argue that although autologous blood is more costly than homologous blood, systematic use of autotransfusion is a valid means to save donated blood and to solve the problem of a chronic lack of blood supplies. The authors conclude that, whenever possible, it is wise practice to limit the use of transfusion therapy and to employ alternatives to homologous blood (anesthetic techniques such as hypothermia, hyperoxygenated ventilation, controlled hypotension, oxygen transporters, and acceptance of low hemoglobin values); when transfusion therapy is necessary, the product of choice is autologous blood.