Book Review

Autotransfusion: Therapeutic principles and trends

N Engl J Med 1999; 340:2009-2010June 24, 1999

Article

Autotransfusion: Therapeutic principles and trends
By Roy Lawson Tawes. 407 pp., illustrated. Grosse Pointe, Mich., Gregory Appleton, 1998. $159. ISBN: 1-56757-061-5

Autotransfusion, a technique in which blood obtained from a patient is at some later time given back to the patient, has existed since the beginning of the 19th century. Until Karl Landsteiner's discovery of the ABO blood groups and the development of a reliable blood-banking system, it was the only way of trying to save a patient with the possibility of sustaining major blood loss. The shortages of allogeneic blood products for transfusion purposes led to the continued development of techniques for autotransfusion. Furthermore, the advantages of autologous blood became clear: no reactions to transfusion, no immunosuppression, and no transmission of infections.

Modern technical aids such as the heart–lung machine and cell separators have further stimulated the development of autotransfusion techniques. A number of thoroughly investigated possibilities for autotransfusion are now available: preoperative donation (with or without the use of erythropoietin), normovolemic hemodilution (less intraoperative blood loss), intraoperative collection of lost blood and return of blood components (erythrocytes) to the patient, immediately or later, and postoperative collection of lost blood (drains) with return of the purified components.

Although autotransfusion would seem to have many advantages, it is not always possible or necessary to apply this technique. In countries with well-organized blood-banking systems, for example, there is a sufficient supply of red cells and other blood components to make the special organization required for autotransfusion superfluous or at least less essential. Furthermore, autotransfusion has disadvantages. It can lead to complications, especially coagulation disorders. There is an extensive literature on this subject, but for the nonexpert it is not always readily accessible and may be difficult to evaluate in relation to the specific situation at hand.

Tawes, with the assistance of 89 coauthors, has succeeded in creating a readily accessible reference book, subdivided into 8 sections and 70 chapters, that will appeal to both experts and other interested readers. He has made it easy for readers to find what they are looking for by providing a brief summary of the contents of each section. Although the structure of the book, in which the many subjects are treated by many different authors, leads to overlapping information here and there, especially in the chapters on clinical applications and complications, all aspects of autotransfusion are touched upon.

The cover and the first few pages are beautifully illustrated, but the remaining illustrations are in black and white, and the photographs are of mediocre quality. In some places, illustrations have been reprinted from other publications, which diminishes the appearance of the page and contrasts with the modern and pleasing typography of the text. Nevertheless, this book provides an up-to-date and complete overview of all aspects of autotransfusion, a topic of wide interest in contemporary transfusion medicine.

John Overbeke, M.D., Ph.D.
, Amsterdam 1070 AZ, the Netherlands