Donor Blood Transfusion

Annually, 100 million blood transfusions with donor blood take place worldwide. A transfusion provides the part or parts of blood components that the patient needs, with red blood cells being the most commonly transfused.

Despite its broad applicability, allogeneic (donor) red blood cell transfusion is still associated with high costs per treatment due to donor blood purchase prices and hospital resource expenses. Additionally, there are health risks, which may result in medical complications, longer recovery times, or even mortality.

Lastly, there is a scarcity of ~30 million units that are lacking in middle- and low-income countries. This scarcity is insufficient to meet minimal demand for this life-saving treatment.

Patient Blood Management

Patient Blood Management is a patient-focused approach to improving patient outcomes by minimizing or avoiding unnecessary exposure to blood components. Cell Salvage is an integral part of Patient Blood Management Programs as it is an autologous blood conservation measure that decreases net perioperative blood loss, maintains postoperative hemoglobin, and reduces the requirements for allogeneic (donor) blood transfusion.

Autologous blood is also considered being a quality improvement as it reduces the patient’s exposure to allogeneic transfusion and the associated risks of infectious and non-infectious complications. While allogeneic (donor) blood is an essential adjunct to healthcare, it is a valuable and limited resource, and allogeneic transfusion can present a risk for patients. Evidence is accumulating for adverse transfusion outcomes that may increase hospital length of stay and present morbidity in identified patient groups.

The collection and re-infusion of the patient’s own red blood cells provide an important contribution to reducing the demand for allogeneic blood. However, it is only one aspect of a strategic approach to safe and appropriate transfusion practice.

General recommendations for PBM cell salvage:

  • Collection of blood for potential cell salvage (‘collect only’ mode) should be considered for surgical procedures where blood loss may exceed 500 ml (or > 10% of calculated total blood volume) in adult patients, or > 8 ml.kg−1 (> 10% of calculated total blood volume) in children weighing > 10 kg.
  • When the use of cell salvage is proposed in surgery for malignancy or infection, an explanation should be given to the patient of the potential risks and benefits, and specific consent should be obtained.
  • The use of leucodepletion filters should be considered during re-infusion of salvaged blood in cancer surgery and when blood is salvaged from an infected surgical field. There is mixed evidence of the benefit of leucocyte depletion filters in obstetrics.