Abstract
BackgroundPreoperative autologous blood donation (PABD) has been declining in use nationally. A subset of patients scheduled for elective surgery, however, continue to be offered and choose this option. Our study aimed to understand the current impact of PABD before scheduled surgical procedures.Study design and methodsA retrospective review was conducted in a single large academic center. Medical records associated with autologous units received in the transfusion service over a two-year period (1/1/2016-12/31/2017) were reviewed. Demographics, units donated, units transfused, wastage, pre-donation hemoglobin (Hb), pre-operative Hb, estimated blood loss (EBL), and clinical specialty were collected.ResultsDuring the study period, 118 patients underwent PABD, donating a total of 141 autologous red blood cell units. Patients who donated autologous units and were subsequently transfused had lower pre-donation Hb compared to patients who were not transfused (13.3 ± 1.4 g/dL vs. 14.3 ± 1.5 g/dL, p=0.004). Pre-operative Hb was lower than pre-donation Hb among both groups (12.1 ± 1.2 g/dL for patients receiving transfusion; 12.9 ± 1.5 g/dL, p=0.011 for patients who were not transfused). The majority of PABD patients (71%) had an estimated blood loss of less than 500 mL. Wastage rate of autologous units was 67%. PABD was disproportionately associated with a minority of surgeons and clinical services.ConclusionWithin our institution, PABD is heavily used amongst a small subset of physicians across multiple surgical specialties and is associated with lower pre-operative Hb, tendency towards overtransfusion, and high rates of wastage of donated units. Our findings reinforce reports of inefficiencies in patient blood management and increased risks to patient health associated with PABD.
Highlights
Preoperative autologous blood donation (PABD) involves patients donating one or more units of their own blood in the weeks preceding scheduled operative procedures
Patients who donated autologous units and were subsequently transfused had lower pre-donation Hb compared to patients who were not transfused (13.3 ± 1.4 g/dL vs. 14.3 ± 1.5 g/dL, p=0.004)
PABD gained significant traction during the 1980s and 1990s after it was recognized that HIV and hepatitis C virus (HCV) could be transmitted by allogeneic blood transfusion [1]
Summary
Preoperative autologous blood donation (PABD) involves patients donating one or more units of their own blood in the weeks preceding scheduled operative procedures. Donated units are stored and transfused to the donor as needed during or after the scheduled procedure. PABD gained significant traction during the 1980s and 1990s after it was recognized that HIV and hepatitis C virus (HCV) could be transmitted by allogeneic blood transfusion [1]. Widespread public measures including rigorous pre-donor screening and increased donor blood testing have significantly reduced the risk of transfusion-transmitted HIV or hepatitis infection. Concerns have arisen regarding the safety of PABD after multiple studies have reported that autologous blood donors present with reduced preoperative hemoglobin (Hb) [36] and are at increased risk of perioperative blood transfusion. Our study aimed to understand the current impact of PABD before scheduled surgical procedures
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