Chapter 107. Transfusion Biology and Therapy (Part 10) Alternatives to Transfusion Alternatives to allogeneic blood transfusions that avoid homologous donor exposures with attendant immunologic and infectious risks remain attractive. Autologous blood is the best option when transfusion is anticipated. However, the cost:benefit ratio of autologous transfusion remains high. No transfusion is a zero- risk event; clerical errors and bacterial contamination remain potential complications even with autologous transfusions. Additional methods of autologous transfusion in the surgical patient include preoperative hemodilution, recovery of shed blood from sterile surgical sites, and postoperative drainage collection. Directed or designated donation from friends and family of the potential recipient has not been safer than volunteer donor component transfusions. Such directed donations may in fact place the recipient at higher risk for complications such as GVHD and alloimmunization. Granulocyte and granulocyte-macrophage colony-stimulating factor are clinically useful to hasten leukocyte recovery in patients with leukopenia related to high-dose chemotherapy. Erythropoietin stimulates erythrocyte production in patients with anemia of chronic renal failure and other conditions, thus avoiding or reducing the need for transfusion. This hormone can also stimulate erythropoiesis in the autologous donor to enable additional donation. Further Readings Blajchman MA: The clinical benefits of the leukoreduction of blood products. J Trauma 60:S83, 2006 Brecher ME, Hay SN: Bacterial contamination of blood components. Clin Micro Rev 18:195, 2005 [PMID: 15653826] ———et al: The Technical Manual , 15th ed. Arlington, VA, American Association of Blood Banks, 2005 Busch MP et al: A ne w strategy for estimating risks of transfusion transmitted viral infections based on rates of detection of recently infected donors. Transfusion 45:254, 2005 [PMID: 15660836] Raghavana M, Marik PE: Anemia, allogeneic blood transfusion, and immunomodulation in the critically ill. Chest 127:295, 2005 Sheppard CA et al: Transfusion- related acute lung injury. Hematol Oncol Clin North Am 21:163, 2007 [PMID: 17258125] Bibliography Agre P, Cartron JP: Molecular biology of the Rh antigens. Blood 78:551, 1991 [PMID: 1907207] Burthem J, Roberts DJ: The pathophysiology of variant Creutzfeldt- Jakob disease: The hypotheses behind concerns for blood components and products. Br J Haematol 122:3, 2003 [PMID: 12823340] Carson JL et al: Mortality and morbidity in pa tients with very low postoperative hemoglobin levels who decline blood transfusion. Transfusion 42:812, 2002 [PMID: 12375651] Corwin HL et al: The CRIT study: Anemia and blood transfusion in the critically ill—Current clinical practice in the United Stat es. Crit Care Med 32:39, 2004 [PMID: 14707558] Etchson J et al: The cost effectiveness of preoperative autologous blood donations. N Engl J Med 332:719, 1995 Fang CT et al: Detection of bacterial contamination in apheresis platelet products: American R ed Cross experience, 2004. Transfusion 45:1845, 2005 [PMID: 16371037] Hebert PC et al: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409, 1999 [PMID: 9971864] Hillyer CD et al (eds): Blood Banking and Transfusion Medicine: Basic Principles and Practices, 2d ed. Philadelphia, Churchill Livingstone, 2006 Kitchen AD, Chiodini PL: Malaria and blood transfusion. Vox Sang 90:77, 2006 [PMID: 16430664] Leiby DA: Babesiosis and blood trans fusion: Flying under the radar. Vox Sang 90:157, 2006 [PMID: 16507014] Rubella P et al: A multicenter randomized study of the threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. N Engl J Med 337:1870, 1997 Slichter SJ et al: Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients. Blood 1005:4106, 2005 Stubbs JA: Alternatives to blood product transfusion in the critically ill: Erythropoietin. Crit Care Med 34(Suppl 5):160, 2006 Taylor RW et al: Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med 34:2302, 2006 [PMID: 16849995] . Chapter 107. Transfusion Biology and Therapy (Part 10) Alternatives to Transfusion Alternatives to allogeneic blood transfusions that avoid homologous. (eds): Blood Banking and Transfusion Medicine: Basic Principles and Practices, 2d ed. Philadelphia, Churchill Livingstone, 2006 Kitchen AD, Chiodini PL: Malaria and blood transfusion. Vox Sang. immunologic and infectious risks remain attractive. Autologous blood is the best option when transfusion is anticipated. However, the cost:benefit ratio of autologous transfusion remains high. No transfusion