La diminution de l’autotransfusion programmée en France ne s’est pas accompagnée d’une augmentation de consommation de concentrés de globules rouges homologues

Abstract

The use of preoperative autologous blood transfusion has dramatically decreased in France. The aim of this study was to evaluate the evolution of practice both of autologous and homologous Red Blood Cells (RBC) concentrates transfusion between 2002 and 2005, and to asses the consequences of the highlighted changes.Data on blood transfusion are collected and validated nationwide by a network of regional coordinators of haemovigilance. For each hospital, from 2002 to 2005, the annual changes in the number of transfused homologous and autologous RBC have been evaluated. The ratio of preoperative autologous RBC, number of autologous RBC divided by the number of all RBC, has also been calculated. Hospitals have been split into three cohorts, according to their 2005 autologous RBC ratio. For each cohort, correlations between the variations of the number of autologous, homologous and total RBC in each hospital have been studied.Data have been validated for 22 French regions that performed 71.8% of the total French transfusion in 2004. In 2005, 1,831,544 labile blood products have been transfused in 1197 hospitals and clinics among which 379 have used preoperative autologous transfusion. A total of 37,289 autologous RBC have been transfused in 2003, 28,689 in 2004 (-23.1%) and 17,758 in 2005 (-38.1%). The first cohort of 269 hospitals had a ratio of autologous RBC under 3%, the second cohort of 38 hospitals, a ratio between 3 and 6%, while the third cohort of 72 hospitals had transfused 6% or more of autologous RBC. In the two first cohorts, non-surgical activities were so large that it was impossible to assess the changes in surgical use of transfusion. The third cohort, with a ratio of 6% or more, was essentially devoted to surgery (88% of beds). These hospitals and clinics have transfused 13,076 autologous RBC in 2002 and 8583 in 2005 (-34.4%). In this group, there was a statistical correlation between the decrease of autologous RBC and the decrease of total RBC (r(2)=0.36), and no increase in the transfusion of homologous RBC has been observed. During the same period, neither hospitals nor clinics showed any decrease of their surgical activity. The drop of autologous RBC transfusion led to a decrease of the total number of RBC transfused and thus, to a decrease of the global exposure to transfusion hazard.The present results confirmed a decline of preoperative autologous transfusion in France, between 2002 and 2005. Meanwhile no supplementary need of homologous RBC has been observed among hospitals, performing surgery that formerly had a high ratio of autologous RBC.