Pre-operative Autologous Donation (PAD) &
Acute Normovolaemic Haemodilution (ANH)

Pre-operative Autologous Donation (PAD)

Technique not currently recommended.

Pre-operative Autologous Donation prior to planned surgery has been used extensively in the USA. In practice the patient goes to theatre with a lower than normal Hb and there has been no evidence that these patients receive any less allogeneic blood, so this technique is no longer recommended as routine. In rare cases of unusual antibody formation or in a situation of blood shortage, it may be considered but it can only be carried out in premises licensed by the MHRA as a blood establishment. Additional information can be obtained from from the BCSH approved document Guidelines for policies on Alternatives to Allogeneic Blood Transfusion 1. Predeposit Autologous Blood Donation and Transfusion (2006) www.bcshguidelines.com

Acute Normovolaemic Haemodilution (ANH)

Technique not currently encouraged.

This is a procedure where, once the patient is anaesthetised, several units of blood are collected in the anaesthetic room. In theory the patient is transfused with crystalloids until surgical haemostasis is achieved then post-operatively the patient’s own blood is reinfused.

Adverse events include ischaemia, fluid overload and mis-identification of blood. A recent meta-analysis in Transfusion (¹) supports only modest benefits and therefore this technique is not currently encouraged.

(¹) Segal, J. B., Blasco-Colmenares, E., Norris, E.J., Guallar, E. (2004) Preoperative acute normovolaemic haemodilution: A meta-analysis. Transfusion, 44(5) 632-644.