Predeposit Autologous Blood Donation (PAD) (bsh 2024)
Headline: PAD is no longer recommend with the exception of one specific scenario
defintion
Predeposit autologous blood donation (PAD) is the collection and storage of blood from a person prior to elective surgery so that it can be transfused in the event that transfusion is required due to blood loss or anaemia.
Recommendations
PAD is only recommended for patient with rare blood groups or who have multiple blood group antibodies, which make compatible allogeneic blood difficult to obtain.
It is no longer recommended for the other indications outline in the previous 2007 BCSH guideline.
limitations
PAD introduced to mitigate risks of blood-borne viruses, which is now addressed through other processes.
—> but lack of high quality data to support the clinical efficacy of PAD
Proposed Benefits
Reduced exposure to blood-borne viruses
Reduced exposure to allogeneic blood
—> but in both cases, PAD has been associated with an increase in overall transfusion rates due to iatrogenic anaemia from the PAD collection.
PAD-specific Risks
Iatrogenic anaemia +/- iron deficiency from the autologous collection
Blood wastage due to the PAD not being transfused
Or conversely, a lower transfusion threshold because unit available and a preference not to waste them
Technical difficulties, e.g. vascular access in paediatric patients
Absolute contraindications include serious cardiac disease and active bacterial infection
Most other risks of transfusion persist, or are even increased:
Human factors - procedure outside normal practice —> increases risks in labelling, recording and storage
Bacterial contamination
Non-infectious transfusion risks remain - e.g. TACO
Trial Data
No RCT from UK
J Bone Joint 2002 – 96 patients for elective hip surgery – autologous donor arm were actually more anaemic post-op than non-donors. No other difference in outcomes. None of 96 patients received an allogeneic transfusion. 41% wastage of the autologous units.
Meta-Analysis 1998 – concluded minimal benefit in reducing need for allogeneic blood but that PAD still carries some of the risks of transfusion.