口腔悪性腫よう手術における術前貯血式および希釈式自己血輪血の適応

Abstract

Predeposit autologous blood transfusion combined with recombinant human erythropoietin (r-HuEPO) has been used at our department since 1995 in patients undergoing operations for oral malignant tumors. This decision was based on studies of blood loss and homologous transfusions in past operations. In this report we discuss the indications, methods and issues of autologous blood transfusion in patients undergoing operations for oral malignant tumors.Among 88 patients who underwent operations for oral malignant tumors between 1993 and 1995, 40 had blood loss of over 600ml and 24 (60%) received homologous transfusions. We estimated the average blood loss according to the operation procedure by dividing the patients into seven groups depending on the extent of resection of the primary lesion and whether or not radical neck dissection and reconstruction were performed.Predeposit autologous blood transfusion combined with recombinant human erythropoietin (r-HuEPO) was given to 13 patients who suffered blood loss of over 600ml during operations performed 1 year since June 1995. The volume of predeposit blood ranged from 400 to 1600ml, averaging 1015ml.As for the effect of rHuEPO, five patients showed an excellent response and three showed a moderate response; the response rate was 67%(8/13). Blood loss up to 2200ml could be compensated by predeposit autologous blood transfusion of 1600ml. Therefore, predeposit autologous blood transfusion combined with r-HuEPO was considered safe and effective when used in patients who undergo operations for oral malignant tumors and have a large volume of blood loss.Based on our clinical experience, we established schedules for collection of 800, 1200, and 1600 ml of predeposit autologous blood within 6 weeks with the use of MAP preservative solution.