Autologous Blood Transfusion Explained: What You Need to Know Before Surgery

🔷 Introduction

If you’ve been to a hospital with orthopedic or obstetrics and gynecology departments, you may have heard staff mention something like, “his/her own blood has been prepared for surgery.”

In this article, I will provide a clear explanation of autologous blood transfusion, covering everything from the basics to its benefits and important points to consider.

First, I will explain the common method of Predeposit Autologous Donation, and then I will discuss Intraoperative Cell Salvage, which is performed during surgery.

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What is Autologous Blood Transfusion—and Why is it Used?

As mentioned above, autologous blood transfusion is a method of transfusing a patient’s own blood during a procedure like surgery. There are two main types (others exist, but will be omitted here): the predeposit method, where you donate your own blood in advance for storage, and the cell salvage method, where blood lost during surgery is collected, cleaned, and returned to your body.

A system of blood donation exists for transfusing another person’s blood (allogeneic blood), so why go to the trouble of using your own? The biggest reason is simple: your own blood is the safest blood for you.

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The Two Major Benefits of Autologous Blood Transfusion

① Eliminates the Risk of Donor-Derived Infections and Immune Reactions

Donated blood is subjected to rigorous testing and is extremely safe. However, the risk of infection from unknown viruses or side effects from immune reactions like allergies cannot be completely eliminated.

Autologous blood, being your own, fundamentally avoids these risks, including TRALI (Transfusion-Related Acute Lung Injury). Problems related to irregular antibodies are also avoided. That said, it is crucial to prevent microbial contamination during the blood draw and to ensure proper storage (at 4–6°C for up to 35 days).

② Conserves the Limited Medical Resource of Donated Blood

The blood supply for transfusions is supported by the goodwill of volunteer donors. It is not an unlimited resource. In Japan, the number of donors is trending downward, especially due to an aging population and other recent societal changes. Furthermore, blood shortages were reported during the COVID-19 pandemic.

Using autologous blood for surgeries with anticipated blood loss is also vital for conserving this finite resource for patients who truly need donated blood.

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Predeposit Donation vs. Intraoperative Cell Salvage

🔷 [Method 1] Predeposit Autologous Donation | The “Store-in-Advance” Approach

This is the most common method, performed when a surgery date is scheduled and there is sufficient time for the donation process. It cannot be used for emergency surgeries because there is no time to collect the blood.

🤔 What Types of Surgery Is It Used For?

It is generally performed for surgeries where blood loss is expected to be 15% or more of the circulating blood volume (approximately 500–1000 mL).

🤔 Is Everyone Eligible?

A key condition is having no anemia (a hemoglobin level of 11.0 g/dL or higher is the benchmark). Drawing blood from an anemic patient would only worsen their condition. Other contraindications include systemic infections or suspected infections. There is no specific age limit as long as the patient’s general condition is stable.

This method is especially recommended for patients with rare blood types, such as RhD-negative, or those with irregular antibodies (as there is a risk that compatible blood cannot be prepared quickly in an emergency).

🤔 When and How Much is Collected?

Blood is typically drawn starting 2 to 3 weeks before the surgery, usually once a week.

The standard volume per collection is 400 mL, and it’s common to store a total of 400–800 mL. This can be repeated as needed, with a maximum possible storage of 1200–1500 mL.

After the draw, iron supplements are often prescribed to prevent anemia (and in some cases, hematopoietic agents like erythropoietin are also used).

[Note] Because the stored blood is refrigerated, the platelets, which help blood clot, lose their function. It’s important to understand that this method is primarily for replenishing red blood cells.

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🔷 [Method 2] Intraoperative Cell Salvage | The “Recycle-During-Surgery” Approach

This method is widely known by the name of the medical device, Cell Saver. It works by suctioning blood lost during surgery, washing it in a machine to isolate the red blood cells, and then returning them to the patient’s body. It is particularly useful in surgeries where heavy blood loss is common.

It is generally indicated when blood loss reaches 800–1000 mL or about 20% of the circulating blood volume.

🤔 What Are the Characteristics of the Recovered Blood?

It is washed by a special machine, and components other than red blood cells (like clotting factors and platelets) are removed.

Therefore, this method alone cannot supplement the blood’s ability to stop bleeding.

Additionally, drugs used during surgery, such as catecholamines and anticoagulants, are not removed, so caution is required upon reinfusion.

[Other Important Notes]
In cancer surgery, this method is generally not performed because it is difficult to completely remove cancer cells mixed in the blood, creating a risk of spreading them back into the body.
However, in some cancer surgeries with a risk of life-threatening hemorrhage, it may be used cautiously if the benefits are judged to outweigh the risks. In such cases, additional measures are taken, such as using a leukocyte-reduction filter or, as is done in Germany, irradiating the blood before reinfusion.

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Summary

😊Pros

• No risk of infection or immune reactions, since another person’s blood is not used
• Conserves the limited medical resource of donated blood

😞Cons

• Predeposit Method: Can cause anemia due to repeated blood draws; stored blood quality degrades over time; blood may go to waste if surgery is postponed
• Cell Salvage Method: Cannot return clotting factors or platelets; may not be usable in cancer surgeries; requires special equipment

Key Points by Method

• Predeposit: Suited for planned surgeries with anticipated blood loss; blood is drawn and stored beforehand
• Cell Salvage: Used in surgeries with significant intraoperative blood loss; blood lost during the operation is collected, washed, and reinfused