HIGHLIGHTS
•There are no objective and concordant answers among the studies, regarding the use of autologous blood transfusion in digestive tract surgeries.
•There is strong evidence of less recurrence of digestive tumors when using autologous transfusion.
•The autologous blood transfusion contains the immunosuppression associated to the operative trauma, but it may also have complications and higher cost of collection and handling.
•It is suggested that the study of this practice be encouraged, aiming to observe the possible deleterious effects and benefits.
ABSTRACT
Background:
The use of autologous blood transfusion in digestive tract surgeries, whether after preoperative blood collection or intraoperative blood salvage, is an alternative to allogeneic blood, which brings with it certain risks and shortage, due to the lack of donors. Studies have shown lower mortality and longer survival associated with autologous blood, however the theoretical possibility of spreading metastatic disease is still one of the limiting factors of its use.
Objective:
To evaluate the application of autologous transfusion in digestive tract surgeries, noting the benefits, damages and effects on the spread of metastatic disease.
Methods:
This is an integrative review of the literature available in the PubMed, Virtual Health Library and SciELO databases, by searching for “Autologous Blood Transfusion AND Gastrointestinal Surgical Procedures”. Observational and experimental studies and guidelines published in the last five years in Portuguese, English or Spanish were included.
Results:
Not all patients benefit from blood collection before elective procedures, with the time of surgery and hemoglobin levels some of the factors that may indicate the need for preoperative storage. Regarding the intraoperative salvaged blood, it was observed that there is no increased risk of tumor recurrence, but the importance of using leukocyte filters and blood irradiation is highlighted. There was no consensus among the studies whether there is a maintenance or reduction of complication rates compared to allogeneic blood. The cost related to the use of autologous blood may be higher, and the less stringent selection criteria prevent it from being added to the general donation pool.
Conclusion:
There were no objective and concordant answers among the studies, but the strong evidence of less recurrence of digestive tumors, the possibility of changes in morbidity and mortality, and the reduction of costs with patients suggest that the practice of autologous blood transfusion should be encouraged in digestive tract surgeries. It is necessary to note if the deleterious effects would stand out amidst the possible benefits to the patient and to health care systems.
Keywords:
Blood Transfusion; autologous; digestive system surgical procedures; neoplasms