The effective use of automated apheresis of autologous red cells in elective orthopaedic and major urological surgery – a rural hospital experience

Abstract

The use of automated apheresis of autologous red cells was investigated to assess the effectiveness of one to two collections using this procedure compared to the standard technique of three to four whole blood collections via venesection. Patient comfort and satisfaction, complications, cost, staff workload and utilization of the product were analyzed. From August 1999 to February 2000, 38 patients underwent red cell collection prior to elective orthopaedic or urological surgery. The patients ranged in age from 38 to 77 yr (62±10 yr). All patients preoperatively met specific height, weight, and haemoglobin criteria. Patients living in isolated areas and those with underlying medical conditions were specifically recruited so that their treatment would be limited to one intervention. Blood parameters were measured pre- and post-donation, and pre- and post-transfusion. The units collected and used were recorded, and the product utilization calculated. Thirty-two patients underwent the apheresis procedure (dual bag collection), one unit was collected from one patient and four units were collected from the remaining five patients. Fourteen patients also donated whole blood. Autologous red cells were used intra-operatively in 33 cases. Both red cells and whole blood were transfused in 14 cases. On average, over 75% of the red cell product was utilized and the post-transfusion haemoglobin values were comparable to those observed after whole blood transfusion. No surgical complications were associated with the red blood collection procedure. Donor tolerance/reaction was evaluated by a registered nurse during each procedure. Of the 43 collections, 41 resulted in no side effects or mild side effects associated with feedback. One patient demonstrated a moderate vaso-vagal response at the end of the second cycle and another patient developed severe citrate effects, a mild vaso-vagal response as well as mild responses resulting from vascular fluid volume shift and/or red blood cell loss. Patient comfort and satisfaction were assessed using a questionnaire. Most patients felt no discomfort during or after the procedure. Among those who experienced some discomfort, some noted feelings of numbness and coldness during the procedure and the most common symptom after the procedure was fatigue. All patients said that they would use this procedure again if required. The cost of apheresis red cell collection was compared to that of whole blood venesection collection taking into consideration the consultant time, nursing time, equipment and number of serology assays required. The absolute cost of collecting two units of red cells via apheresis is less than that needed to collect three units of blood via venesection despite the cost of the collection set since fewer serology screens were required and the total nursing time was less.