Autotransfusion and blood conservation in urologic oncology.

Autotransfusion is the reinfusion of the patient's own blood. Currently utilized forms include preoperative donation, perioperative hemodilution, and intraoperative salvage. The principal benefit of autotransfusion is a reduction in the complications associated with receipt of homologous blood products. Principal among these are febrile reactions, allergic and hemolytic reactions, alloimmunization, and the transmission of hepatitis and acquired immune deficiency syndrome. An additional benefit in the management of cancer patients is the avoidance of transfusion induced immunosuppression. Predeposit autologous transfusion is a simple and safe method to reduce patient's requirements for exogenous blood. Although well suited for cancer patients, predeposit programs remain underutilized with only 5% participation. Perioperative hemodilution can be a valuable adjunct in selected patients. Although the presence of malignancy has been regarded as a contraindication to the use of intraoperative autotransfusion, preliminary reports suggest that intraoperative autotransfusion can be safely used in patients undergoing surgery for urologic malignancies.