Preoperative autologous blood donation versus intraoperative blood salvage: Intraindividual analyses and modeling of efficacy in 1103 patients

Background: Preoperative autologous blood donation (PABD) and intraoperative blood salvage (IBS) represent established blood conservation measures. However, data comparing PABD to IBS are very sparse. Study design and methods: We analyzed data from 1103 patients undergoing PABD and subsequent major orthopedic surgery in one center. We then used a validated model to compare PABD to IBS. We calculated maximal allowable blood losses (MABLs) for both IBS and PABD. We also identified criteria for efficacious use of either PABD or IBS. Our calculations were based on exclusive application of either technique, complete exhaustion of predeposited or salvaged blood, and one round of IBS. Results: The vast majority of patients would have tolerated greater MABLs if subjected to IBS rather than PABD (425 of 432 with 1 PABD unit, 580 of 664 patients with 2 PABD units, 3 of 7 patients with 3 PABD units). For a few patients, however, our model demonstrated greater MABL with PABD than with IBS. These patients were characterized by 1) lower initial hematocrit (Hct), 2) recovery from PABD with return to baseline Hct or above by the time of surgery, and 3) longer time between first PABD and surgery. Conclusion: IBS appears to be the superior blood conservation technique if PABD cannot be performed under optimal conditions. Tolerable predonation anemia and sufficient time for regeneration appear to be crucial for post-PABD erythropoiesis. If these goals cannot be accomplished, PABD should be abandoned and be replaced by IBS.