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March 2, 1990

Autologous Blood Donations Before Elective Cardiac Surgery-Reply

Author Affiliations

Beth Israel Hospital Boston, Mass

Beth Israel Hospital Boston, Mass

JAMA. 1990;263(9):1202. doi:10.1001/jama.1990.03440090032021

In Reply.—  We appreciate Dr Avoy's comments concerning our article and would like to respond to the two points he makes in the letter. First, a question is raised about the need to administer saline to donors concomitant with blood collection to forestall reactions. The pathophysiology of the "vasovagal reaction" during and following blood donation, even in normal donors, is poorly understood. The primary cause is probably neurological. However, the extent of the acute decrease in blood volume resulting from donation must also be important, since the reaction rate in donors of 200 mL of blood is lower (1.3%)1 than in donors of 400 to 500 mL (3.7% to 6.0%).2,3 Fortunately for the healthy homologous donor, vasovagal reactions appear to be of minimal or no consequence. Whether the patient with coronary artery atherosclerosis is as resilient is unknown. Our use of saline to mute the effects of an