Preoperative Autologous Blood Donation in Patients with Rheumatoid Arthritis: Analysis on the Effectiveness in Increasing Red Blood Cell Mass

Abstract

Background: Analysis on the effectiveness of preoperative autologous blood donation (PABD) on increase in red blood cell mass (+RBC) in patients with rheumatoid arthritis (RA). Patients and Methods: 199 RA patients (52 men and 147 women) participating in a PABD program prior to primary or revision arthroplasty of the hip or knee joint were included into the study. RA of the patients was known for many years and diagnosed according to the criteria of the American Rheumatism Association. Data were collected either retrospectively from the patients’ records or from actual records of patients being scheduled for PABD and surgery. Patients’ ability to predeposit was verified by an anesthetist in charge of the autologous blood bank. Patients considered suitable for this elective surgical intervention were suitable for PABD as well according to the standard criteria for PABD (compensated organ function, no signs of systemic infections, relevant laboratory parameters within their physiological limits except for a ‘normal’ hemoglobin/hematocrit (Hb/ hct) level), and the ASA physiological status score. Data on +RBC were analyzed for differences between men and women as well as between manual and mechanical PABD. Statistical significance was considered if p < 0.05 (with Bonferroni correction where appropriate). Results: When starting with PABD, the hct of the patients amounted to hct_init = 33.6 ± 3.9%; immediately before operation, hct was hct_preop = 30.7 ± 4.0% (p < 0.05). +RBC for all patients was 51 ± 82 ml, with no difference between men (45 ± 97 ml) and women (53 ± 76 ml). The interval between donation and surgery (IDOP) was 18.3 ± 12 days for all patients, with no difference between men (17.6 ± 11 days) and women (18.6 ± 12 days). 48.7% of the patients generated a +RBC of ≤50 ml, while 13.0% only produced a +RBC of >150 ml, including those 4.5% of patients generating +RBC at least equal to 1 U of packed red blood cells (190 ml). Patients with mechanical PABD generated a higher +RBC than those with manual PABD (70 ± 68 ml versus 38 ± 88 ml; p < 0.05); IDOP did not differ between both groups (mechanical PABD 19 ± 10 days, manual PABD 17 ± 14 days). Among a variety of parameters, only patient’s RBC massinit, IDOP, and RBC mass_donated were shown to have an impact on +RBC; neither age nor gender nor ASA physiological status score were of relevance for +RBC. Conclusions: Our analysis demonstrates that in RA patients the 1-unit PABD concept is poorly effective in increasing total RBC mass. To rise effectiveness, IDOP should be prolonged to at least 4 weeks prior to surgery, and blood volume_donated/RBC mass_donated should be increased in order to stimulate erythropoiesis more intensively. Additionally, our data suggests to perform only 1 PABD in RA patients, but with a blood volume_donated/RBC mass_donated being greater than in the routine PABD procedure.