Autologous transfusion techniques: A systematic review of their efficacy: A systematic review of their efficacy

Paul A. Carless, Annette J. Moxey, Dianne O'Connell, David Henry

Research output: Contribution to journalArticleResearchpeer-review

105 Citations (Scopus)

Abstract

Shortages of donor blood and fears of transmitted infections have prompted the use of a range of blood-sparing techniques in the peri-operative period. We conducted a systematic review of three techniques that involve the re-infusion of a patient's blood - pre-operative autologous blood deposit (PAD), acute normovolaemic haemodilution (ANH) and cell salvage (CS). We examined the effects of these interventions on the need for peri-operative allogeneic red blood cell transfusion and on clinical outcomes. Controlled clinical studies were identified by computer searches of comprehensive electronic databases and bibliographic searches of published articles. The literature search retrieved a total of 68 randomized trials (RCTs) and 81 controlled observational studies that included data from over 34000 individuals. In summary, the RCTs found that autologous transfusion techniques consistently reduced the frequency of allogeneic transfusions, with intervention effect sizes ranging from a relative 63% reduction (95% CI 46-74%) with PAD, to 42% (27-53%) with CS and to 31% (16-44%) with ANH. Non-randomized studies reported larger effect sizes than RCTs. PAD increased overall transfusion rates by 30% (95% CI 12-48%) and reduced preoperative haemoglobin levels by an average of 1.23 g dL -1. Intervention effects were substantially reduced when these techniques were performed under transfusion protocols. Interpretation of the studies was hampered by serious methodological weaknesses, particularly inadequate randomization techniques, unblinded measurements and the subjective nature of the outcome variables. The studies reported few clinical outcome and adverse event data. Previous claims regarding reduced rates of mortality and infection with autologous transfusions were not confirmed.

Original languageEnglish
Pages (from-to)123-144
Number of pages22
JournalTransfusion Medicine
Volume14
Issue number2
DOIs
Publication statusPublished - Apr 2004
Externally publishedYes

Fingerprint

Hemodilution
Bibliographic Databases
Erythrocyte Transfusion
Random Allocation
Infection
Blood Donors
Fear
Observational Studies
Hemoglobins
Mortality
Clinical Studies

Cite this

Carless, Paul A. ; Moxey, Annette J. ; O'Connell, Dianne ; Henry, David. / Autologous transfusion techniques: A systematic review of their efficacy : A systematic review of their efficacy. In: Transfusion Medicine. 2004 ; Vol. 14, No. 2. pp. 123-144.
@article{46552f0bb26f462a9ddee8180012c378,
title = "Autologous transfusion techniques: A systematic review of their efficacy: A systematic review of their efficacy",
abstract = "Shortages of donor blood and fears of transmitted infections have prompted the use of a range of blood-sparing techniques in the peri-operative period. We conducted a systematic review of three techniques that involve the re-infusion of a patient's blood - pre-operative autologous blood deposit (PAD), acute normovolaemic haemodilution (ANH) and cell salvage (CS). We examined the effects of these interventions on the need for peri-operative allogeneic red blood cell transfusion and on clinical outcomes. Controlled clinical studies were identified by computer searches of comprehensive electronic databases and bibliographic searches of published articles. The literature search retrieved a total of 68 randomized trials (RCTs) and 81 controlled observational studies that included data from over 34000 individuals. In summary, the RCTs found that autologous transfusion techniques consistently reduced the frequency of allogeneic transfusions, with intervention effect sizes ranging from a relative 63{\%} reduction (95{\%} CI 46-74{\%}) with PAD, to 42{\%} (27-53{\%}) with CS and to 31{\%} (16-44{\%}) with ANH. Non-randomized studies reported larger effect sizes than RCTs. PAD increased overall transfusion rates by 30{\%} (95{\%} CI 12-48{\%}) and reduced preoperative haemoglobin levels by an average of 1.23 g dL -1. Intervention effects were substantially reduced when these techniques were performed under transfusion protocols. Interpretation of the studies was hampered by serious methodological weaknesses, particularly inadequate randomization techniques, unblinded measurements and the subjective nature of the outcome variables. The studies reported few clinical outcome and adverse event data. Previous claims regarding reduced rates of mortality and infection with autologous transfusions were not confirmed.",
author = "Carless, {Paul A.} and Moxey, {Annette J.} and Dianne O'Connell and David Henry",
year = "2004",
month = "4",
doi = "10.1111/j.0958-7578.2004.0489.x",
language = "English",
volume = "14",
pages = "123--144",
journal = "Transfusion Medicine",
issn = "0958-7578",
publisher = "Wiley-Blackwell",
number = "2",

}

Autologous transfusion techniques: A systematic review of their efficacy : A systematic review of their efficacy. / Carless, Paul A.; Moxey, Annette J.; O'Connell, Dianne; Henry, David.

In: Transfusion Medicine, Vol. 14, No. 2, 04.2004, p. 123-144.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Autologous transfusion techniques: A systematic review of their efficacy

T2 - A systematic review of their efficacy

AU - Carless, Paul A.

AU - Moxey, Annette J.

AU - O'Connell, Dianne

AU - Henry, David

PY - 2004/4

Y1 - 2004/4

N2 - Shortages of donor blood and fears of transmitted infections have prompted the use of a range of blood-sparing techniques in the peri-operative period. We conducted a systematic review of three techniques that involve the re-infusion of a patient's blood - pre-operative autologous blood deposit (PAD), acute normovolaemic haemodilution (ANH) and cell salvage (CS). We examined the effects of these interventions on the need for peri-operative allogeneic red blood cell transfusion and on clinical outcomes. Controlled clinical studies were identified by computer searches of comprehensive electronic databases and bibliographic searches of published articles. The literature search retrieved a total of 68 randomized trials (RCTs) and 81 controlled observational studies that included data from over 34000 individuals. In summary, the RCTs found that autologous transfusion techniques consistently reduced the frequency of allogeneic transfusions, with intervention effect sizes ranging from a relative 63% reduction (95% CI 46-74%) with PAD, to 42% (27-53%) with CS and to 31% (16-44%) with ANH. Non-randomized studies reported larger effect sizes than RCTs. PAD increased overall transfusion rates by 30% (95% CI 12-48%) and reduced preoperative haemoglobin levels by an average of 1.23 g dL -1. Intervention effects were substantially reduced when these techniques were performed under transfusion protocols. Interpretation of the studies was hampered by serious methodological weaknesses, particularly inadequate randomization techniques, unblinded measurements and the subjective nature of the outcome variables. The studies reported few clinical outcome and adverse event data. Previous claims regarding reduced rates of mortality and infection with autologous transfusions were not confirmed.

AB - Shortages of donor blood and fears of transmitted infections have prompted the use of a range of blood-sparing techniques in the peri-operative period. We conducted a systematic review of three techniques that involve the re-infusion of a patient's blood - pre-operative autologous blood deposit (PAD), acute normovolaemic haemodilution (ANH) and cell salvage (CS). We examined the effects of these interventions on the need for peri-operative allogeneic red blood cell transfusion and on clinical outcomes. Controlled clinical studies were identified by computer searches of comprehensive electronic databases and bibliographic searches of published articles. The literature search retrieved a total of 68 randomized trials (RCTs) and 81 controlled observational studies that included data from over 34000 individuals. In summary, the RCTs found that autologous transfusion techniques consistently reduced the frequency of allogeneic transfusions, with intervention effect sizes ranging from a relative 63% reduction (95% CI 46-74%) with PAD, to 42% (27-53%) with CS and to 31% (16-44%) with ANH. Non-randomized studies reported larger effect sizes than RCTs. PAD increased overall transfusion rates by 30% (95% CI 12-48%) and reduced preoperative haemoglobin levels by an average of 1.23 g dL -1. Intervention effects were substantially reduced when these techniques were performed under transfusion protocols. Interpretation of the studies was hampered by serious methodological weaknesses, particularly inadequate randomization techniques, unblinded measurements and the subjective nature of the outcome variables. The studies reported few clinical outcome and adverse event data. Previous claims regarding reduced rates of mortality and infection with autologous transfusions were not confirmed.

UR - http://www.scopus.com/inward/record.url?scp=2442438024&partnerID=8YFLogxK

U2 - 10.1111/j.0958-7578.2004.0489.x

DO - 10.1111/j.0958-7578.2004.0489.x

M3 - Article

VL - 14

SP - 123

EP - 144

JO - Transfusion Medicine

JF - Transfusion Medicine

SN - 0958-7578

IS - 2

ER -