Wednesday, April 29, 2009

Considerations For Autologous Blood Donation Before Surgery

Why You May Not Need To Donate Blood Prior To Having Surgery

Donating your own blood before surgery was started in response to the initial AIDs epidemic. This practice was seen as early as the 1980’s. However, great strides have been made and accomplished in making the U.S. blood supply very safe. Here are some considerations before you decide to donate your blood before surgery.

Donating Blood Is A Process Through Which You Experience A Blood LOSS

While the body normally carries a blood volume of 8-12 pints (units) and can easily afford to give up one of those units, there are other considerations when making the decision to self-donate your blood. Those things include age, other co-morbities (other health problems, i.e. heart disease), the type of surgery that you are having, and your general state of health. Giving blood depletes your hematologic (blood making) system. The marrow (inside the bone), which manufactures red blood cells, suffers a shock of sorts when blood is removed from the body. As a result, it rushes to respond to the loss. Along with the marrow, the other systems of the body react to blood loss. (Yes, it is a blood loss of one full unit each time you donate!) When the body experiences a blood loss, the heart, lungs, kidneys, liver and brain-your major and essential organs, as well as your metabolic function are affected. They must work over-time to accommodate the blood loss. (Ever fainted or felt like fainting after donating blood? Your body has issued a statement to you that something just happened to it!) The body experiences shock in mild or major ways in response to a shift in its normal equilibrium (homeostasis is the medical term for this). Therefore, your whole body is going to rush to make sure that equilibrium is restored.

How Long Does It Take For Blood Volume To Replenish Itself?

The National Kidney and Transplant Foundation states that the PLASMA portion (about 80% water, but NOT 80% of your total blood loss volume-big difference) is replaced in 24-48 hours. However, it takes 3-5 WEEKS to replace the red blood cell (RBC’s or packed cells) portion of the loss. When considering surgeries, especially moderate-to-high blood loss surgeries, it is important to understand that autologous blood expires after 28 days and cannot be used. (It also cannot be given to someone else other than yourself because it has not gone through the special preparation require to enter the pool of general blood donations offered to the public.)

So, if you donate your own blood and 2 weeks later have a moderate-to-high blood loss surgery (i.e. joint or back surgery, some types of abdominal surgery, or cardiovascular surgery) you will be going into the procedure somewhat compromised. Additionally, you will experience a blood loss of minimal to large proportions, depending on the procedure and any unforeseen complications within or after surgery. Now, certainly you have your “auto-unit” available, if needed, but why deplete yourself only to get it back? Did you really need it in the first place? If you had not given it would you have needed transfusion? And if there is further blood loss during or after surgery (i.e. via post-operative drains from your incision), consider that you may need not only your auto-unit, but also a donor unit or units of blood. If so, the purpose of auto-donation is somewhat defeated. There is clinical evidence that has been sited that states that auto-donation increases the likelihood of peri-operative (the time during and after surgery) blood transfusion in surgeries such as hysterectomy. Additionally, there is some evidence that patients are at risk of ischemic (decreased blood flow) events to organs like the heart, causing myocardial infarction (heart attack).

Other Considerations

There are other considerations when thinking about whether to donate your own blood for surgery. Your age, the sate of your health, your level of physical fitness, recent health history, and number of surgeries within short time spans are just some of the considerations. If you are of advanced age, have other health problems that will affect your surgical outcomes and recovery, have a “heart history” (heart attack, chest pain/angina, artificial valves, etc.) you may want to think twice about auto-donating. While the standard of care for orthopedic surgeries such as joint replacement is for a patient to auto-donate before surgery, it is NOT for everyone. Ask questions, and expect answers before doing so. You can also research for yourself, as there are many internet sites that provide lots of good information to help you with making your decision. Always remember that the last word is with YOU. If you don’t feel comfortable about things, wait, ask more questions, and make the decision that’s best for you.

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