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March 2, 1990

Autologous Blood Donations Before Elective Cardiac Surgery

JAMA. 1990;263(9):1202. doi:10.1001/jama.1990.03440090032020

To the Editor.—  I was intrigued by the excellent report of Owings et al1 in The Journal entitled "Autologous Blood Donations Prior to Elective Cardiac Surgery." They have made a substantial contribution by documenting how benign phlebotomy is, even in what would generally be considered to be a high-risk group. They also demonstrate how effective such a program can be in avoiding the risks still tragically and unavoidably present in homologous blood transfusion. Other points merit specific comment.As the authors point out, hypovolemic symptoms are most unusual following the removal of 10% or less of the circulatory volume. By far the most frequent cause of postphlebotomy hypotension is vasovagal syncope. I am not aware of any mechanism by which saline infusion could be expected to prevent this phenomenon. I urge the investigators to pursue their promise to document the need for this part of the process. If it