From the blood management perspective, the preoperative anemia is of greatest concern. Preoperative anemia is to be avoided.
There is one instance where autologous units may be a reasonable approach to transfusion. This would be when a patient has antibodies to high incidence antigens or multiple antigens that makes finding compatible units very difficult. The operative procedure is one where transfusion is likely and there is sufficient time to collect and freeze multiple units.
In reality, predeposit autologous units were often transfused before surgery or at the beginning of the case because the patient was anemic. Or, the physician transfused the unit simply because it was available, not because the patient needed it. The expense of the predeposit donation was unnecessary in both of these cases. Patients often requested autologous units and some physicians suggested patients "donate" to add to the blood supply. However, most autologous collections were not suitable for transfusion to other patients because the less stringent screening criteria was used and complete infectious disease testing was not performed. Some hospitals had an expiration rate for autologous units of greater than 70%.
To see one collection center's requirements for autologous and directed donations, click here