Autologous blood transfusion may be an acceptable option for patients. Patients with normal hematocrit levels may store autologous blood preoperatively to reduce the need for allogenic blood transfusion and minimize the risk of infections and immunologic problems (193). Recombinant human erythropoietin may increase collection and reduce preoperative anemia in these patients (223,224). Intraoperative blood collection and homologous transfusion can be employed to limit the need for allogenic blood transfusion.
Autologous blood donation is advocated as a safer alternative for the patient; however, the use of preoperative autologous blood donation has come under scrutiny (225,226). Preoperative autologous blood may lead to more liberal blood transfusion, iatrogenic anemia, volume overload, and bacterial contamination (227). Preoperative autologous blood donation is poorly cost-effective (228). The National Heart, Lung, and Blood Institute does not recommend collection of autologous blood for procedures with a likelihood of transfusion less than 10%, such as uncomplicated abdominal and vaginal hysterectomies (229).
Surgical hemostasis is provided by platelet adhesion to injured vessels, which plugs the opening as the coagulation cascade is activated, resulting in the formation of fibrin clots. Functional platelets and coagulation pathways are necessary to prevent excessive surgical bleeding. Platelet dysfunction is encountered preoperatively more frequently than coagulation disorders.
Platelets may be deficient in both number and function. The normal peripheral blood count is 150,000 to 400,000 per mm3, and the normal lifespan of a platelet is approximately 10 days. Although there is no clear-cut correlation between the degree of thrombocytopenia and the presence or amount of bleeding, several generalizations can be made. If the platelet count is higher than 100,000/mm3 and the platelets are functioning normally, there is little chance of excessive bleeding during surgical procedures. Patients with a platelet count higher than 75,000/mm3 almost always have normal bleeding times, and a platelet count higher than 50,000/mm3 is probably adequate. A platelet count lower than 20,000/mm3 often will be associated with severe and spontaneous bleeding. Platelet counts higher than 1,000,000/mm3 are often, paradoxically, associated with bleeding.
If the patient’s platelet count is lower than 100,000/mm3 , an assessment of bleeding time should be obtained. If the bleeding time is abnormal and surgery must be performed, an attempt should be made to raise the platelet count by administering platelet transfusions immediately before surgery. In patients with immune destruction of platelets, human leukocyte antigen (HLA)–matched donor-specific platelets may be required to prevent rapid destruction of transfused platelets. If surgery can be postponed, a hematology consultation should be obtained to identify and treat the cause of the platelet abnormality.