Accelerated erythropoiesis: the hidden benefit of autologous donation

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Abstract
The risks associated with the administration of blood products have increased efforts to avoid homologous transfusions. Preoperative autologous donation has received renewed interest as a method of decreasing homologous transfusion requirements. Autologous donations may also stimulate postoperative erythropoiesis. The purpose of this study is to evaluate the effect of an aggressive autologous donation program on postoperative erythropoiesis. Ten adult male baboons were divided into two groups. The autologous group (n = 5) donated an average of 2 units of blood per week for 5 weeks before operation. The control group (n = 5) had no preoperative treatment. All animals then underwent a laparotomy and exchange transfusion with hetastarch to a final hematocrit of 15 percent. The time required to recover to hematocrits of 20 percent (3.3 vs. 5.7 days, p<0.01), 25 percent (7.0 vs. 8.8 days, p <0.05), and 30 percent (11.1 vs. 17.7 days, p<0.01) was shorter in the autologous group. The autologous group had more intense reticulocytosis during the first 4 postoperative days (p <0.03). The data show that participation in an aggressive autologous donation program improves the erythropoietic response to anemia in the postoperative setting. This represents a hidden benefit of preoperative autologous donations and suggests that more aggressive donation schedules may be clinically beneficial. Recognition of the acceleration of erythropoiesis by autologous donation could further reduce the need for transfusion of homologous blood.

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