Consider the following when making your decision:

• Your risk of getting a disease through a blood transfusion in the United States is very rare. The risk of infection from a blood transfusion is higher in less developed countries.¹
• The most significant risk of having a blood transfusion is having a transfusion reaction because the blood you are given does not match your blood type. This occurs in 1 of 14,000 transfusions and is usually a result of an administrative error in which blood is mislabeled or the label on the blood is misread.¹ This small risk is the same whether you bank your own blood (autologous donation) or receive blood from donors.
• Your body may not have time to replace the blood you banked before the surgery. You may have less blood than normal at the time of the surgery and so can tolerate less blood loss before needing a transfusion. In some cases, it is possible that you would not have needed a transfusion at all if you had not banked blood before your surgery.

Blood transfusion is a medical treatment to replace blood or portions of the blood lost through injury, surgery, or disease.

What is the greatest risk of a transfusion?

The greatest risk of having a blood transfusion is a transfusion reaction. A transfusion reaction may be mild or severe, and a severe reaction can be life-threatening. Transfusion reactions occur when there is an imperfect match between your blood and the blood you are given. Most adverse reactions occur because of an administrative error, either mislabeling of a unit of blood by the laboratory or misreading of the label by the doctors and nurses before the blood is given to you. Because of the potential for a serious reaction, great care is taken to prevent these labeling and reading errors. A transfusion reaction occurs about once in every 14,000 transfusions.¹ It is possible to have a mild transfusion reaction even if your blood and the blood given are properly matched.

Some people, especially those who have had several blood transfusions, produce antibodies against certain components in the blood they receive. The immune system mistakes the new blood as harmful and tries to destroy it. Careful screening helps reduce the risk for these problems.²

The risk for an administrative error is the same whether you bank your own blood before surgery or receive a transfusion of donor blood. It is also possible for an administrative error to result in your receiving the correct blood type but not the blood you banked before your surgery.

What is the risk of infection from a transfusion?

The transmission of viral infections, such as hepatitis or HIV, through blood transfusions has become very rare because of the safeguards enforced by the U.S. Food and Drug Administration (FDA) on the collection, testing, storage, and use of blood. The risk of infection from a blood transfusion is higher in less developed countries.

It is possible for blood to become contaminated with bacteria during or after donation. Transfusion with blood containing bacteria can result in a systemic bacterial infection. The risk for this is the same whether you bank your own blood before surgery or receive a blood transfusion of donor blood.

Is there a risk in banking blood before surgery?

Because blood cannot be stored very long, you must bank your blood a few weeks before your surgery. This may not allow sufficient time for your body to make enough new blood to replace what you banked for your surgery. You may have less blood than normal at the time of the surgery and so be able to tolerate less blood loss before needing a transfusion. In some cases, it is possible that you would not have needed a transfusion at all if you had not banked blood before your surgery.

Can I bank enough blood to cover my surgical need?

Most people are able to safely bank 2 to 4 units of blood before surgery. If you are having major surgery that may require a greater amount of blood than this, you probably cannot bank enough blood before the surgery.

Talk with your surgeon to estimate the amount of blood you might need for your surgery.

If you need more information, see the topic Blood Transfusion.

Your choices are:

• Bank your own blood before your surgery. Note that this option is not totally risk-free and may actually increase your need for a transfusion.
• Do not bank your own blood before surgery. If you need a transfusion, you will receive donor blood from the blood bank.

The decision about whether to bank your blood before surgery takes into account your personal feelings and the medical facts.

Deciding whether to bank blood

Reasons to bank blood before surgery

Reasons not to bank blood before surgery

You are concerned about the risk of getting a viral infection from a blood transfusion. You have a rare blood type that contains antibodies, making a transfusion reaction likely if you receive blood from other donors. You have religious or cultural reasons not to receive blood from other people. Are there other reasons you might want to bank blood before surgery?

You feel the risk of getting a viral infection from transfused blood is acceptably low. Banking your own blood does not reduce the risk of a transfusion reaction. Your surgery is unlikely to require a transfusion. Your surgery is likely to require more blood than you can safely bank before your surgery. You are concerned that banking your blood before surgery may cause you to need a transfusion you would otherwise have avoided. Are there other reasons you might not want to bank blood before surgery?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about banking blood before surgery. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I am concerned about getting a viral infection from a blood transfusion.	Yes	No	Unsure
My surgery may require more blood than I can safely bank beforehand.	Yes	No	Unsure
My surgery is unlikely to require a transfusion.	Yes	No	Unsure
I have an increased risk of a transfusion reaction if I receive blood from other donors.	Yes	No	Unsure
I am concerned that I will need a transfusion I could have avoided if I bank blood.	Yes	No	Unsure
I have religious reasons not to receive a blood transfusion from other people.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to bank or not bank your blood before surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward banking blood before surgery

Leaning toward NOT banking blood before surgery

• Blood Transfusion
• Surgery: What to Expect

Citations

1. Goodnough LT, et al. (2003). Transfusion medicine: Looking to the future. Lancet, 361(9352): 161–169.

2. Klein HG (2007). Transfusion medicine. In DC Dale, DD Federman, eds., ACP Medicine, section 5, chap. 10. New York: WebMD.

Author	Caroline Rea, RN, BS, MS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Joseph O'Donnell, MD - Hematology/Oncology
Last Updated	December 27, 2007