Autologous Blood Donation Research Articles

Ten years of preoperative autologous blood donation in Accra

Preoperative autologous blood donation (PABD) is utilized to circumvent the use of allogenic blood for various reasons. To describe the distribution in terms of demographic characteristic, trends in participation and result of screening test of the PABD programme of the Accra Area Blood Center from 1993-2003. Retrospective descriptive study of PABD in patients scheduled for a variety of elective surgical procedures. Different levels of institutional health care in Accra, Ghana. Data from existing records of patients who had participated in PABD were collated and analyzed Five hundred and forty six (546) females and 89 males participated, with ages ranging between 14-74 years. Majority of the patients (76.7%) underwent gynaecological surgery. A total of 330 (52%) donated one unit only, and 299 (47.1%) donated two units. Majority of the patients (56.4%) had the surgery at the Korle-Bu Teaching Hospital (KBTH). Of the donations, 21 (3.3%), 1 (0.2%), 1 (0.3%) and nil were positive for HBV, HIV I & II, HCV and VDRL respectively. A total of 848 (89.4%) autologous cross-matched units were issued out. There was a steady progressive increase in participation. Mainly adult females scheduled for gynaecological surgeries in KBTH participated, while almost equal proportions donated one or two units of blood which meets the blood needs of most elective surgeries. Therefore healthy patients going for elective surgeries in regions with limited blood supply must be encouraged to enter a PABD Programme. Further studies in this field should evaluate motivational factors for participation.

Autologous blood donation and transfusion in obstetrics and gynaecology at the University of Maiduguri Teaching Hospital Maiduguri, Nigeria.

To evaluate the practicability of autologous blood donation and transfusion in the practice of obstetrics and gynaecology in our environment. A prospective study of 1221 obstetric and gynaecological patients to which autologous blood donation and transfusion was carried out at the University of Maiduguri Teaching Hospital, Maiduguri over an 8 year period (January, 1998 to December, 2005). During the study period, there were 15,267 blood transfusions in the UMTH out of which 5,711 were for Obstetric and Gynaecological patients given a transfusion rate of 47.7% in the unit. Out of the 5711 transfusion in the obstetrics and gynaecology, 1221 were by autologous means; a rate of 21.4%. Of the 3010 transfusion in obstetrics 625 (20.7%) were of autologous blood and of the 2711 transfusion in gynaecological patients 596 (22.1%) were of autologous blood. Preoperative blood donation was done in 598 (95.8%) of the obstetrics autologous blood donation out of which, 40 (6.4%) predeposited 2 units. Five hundred and sixty (94.1%) gynaecological patients had preoperative blood donation out of which, 46 (7.7%) predeposited 2 units. Induction of labour constitutes the major indication 337 (53.9%) for the autologous blood donation in obstetric while the major indication in gynaecology patients was myomectomy (25.7%).The main complications encountered were dizziness, and fainting attack that necessitated re-infusion in one patient. Autologous blood donation and transfusion procedure is feasible in the setting of obstetrics and gynaecology and it does not require high technical procedure.

Efficiency and safety of preoperative autologous blood donation in cardiac surgery: a matched-pair analysis in 432 patients

A shortage of blood products is predicted for the near future in many countries all over the world. Preoperative autologous blood donation (PABD) in cardiac surgery is considered an option to reduce the need of allogeneic blood products. We analysed a 1-year period of our institutional database according to the safety and efficiency of our autologous blood donation programme. All patients who donated autologous blood prior to cardiac surgery were matched to a non-donor according to age, body weight, body mass index, sex, haemoglobin concentration, EuroSCORE, antifibrinolytic therapy and risk for bleeding. We analysed the occurrence of adverse effects during donation in all donors as well as the main perioperative data, haemoglobin levels and the need for allogeneic blood transfusion in all patients. There were no major cardiac events such as myocardial infarction, worsened cardiac insufficiency or death in the donor group during the PABD process. A total of 216 patients could be matched. Exposure to allogeneic blood products was significantly reduced in the donor group (packed red cells 70 patients (pts) vs 118 pts (p<0.001), fresh frozen plasma 26 pts vs 54 pts (p=0.001), platelets 10 pts vs 22 pts (p=ns)). There were no reports of transfusion-related side effects. Further, there was no difference in haemoglobin concentrations at postoperative day 1 and at discharge. In this large matched-pair analysis without the need for risk stratification, PABD reduces the need for allogeneic blood products in adult cardiac surgery. In a carefully selected cohort, PABD is a safe and efficient alternative to allogeneic transfusion.

Safety of blood donation from individuals with treated hypertension or non‐insulin dependent type 2 diabetes – a systematic review

This systematic review was aimed at finding evidence for the safety of blood donation by individuals with treated hypertension or type 2 diabetes. It was undertaken as part of a wider project to re-evaluate exclusion criteria for UK blood donors with a view to increasing eligibility. Searches were undertaken in the Cochrane Library to 2008, MEDLINE (1950 onwards), EMBASE (1974 onwards), CINAHL (1982 onwards), BNID (1994 onwards), the NHSBT SRI Handsearching Database and the Web of Science (all years) to February 2008. Planned analysis was largely descriptive. We identified only 16 relevant papers. None of the identified studies directly addressed the review questions and methodological appraisal highlighted a number of deficiencies. However all included papers provided contributory data and the findings were consistent. No study found any evidence of increased risk to homologous (allogeneic) or autologous blood donors with treated hypertension or with raised baseline systolic blood pressure up to 200 mmHg. We found very few data relating to blood donation by diabetic subjects. No identified study indicated that raised baseline blood pressure level, treated hypertension or diabetes was predictive of increased adverse reactions in blood donors but the level of overall evidence was limited. This is the first attempt to systematically review a donor area as part of an approach to change longstanding practice recommendations, and may have implications for other recommendations for changes in donor acceptance criteria.

Antifibrinolytics in Major Orthopaedic Surgery

Total joint arthroplasty and deformity surgery of the spine can require complex reconstructive procedures accompanied by the potential for major blood loss. In an attempt to minimize the perioperative blood loss associated with these procedures, recent focus has concentrated on the efficacy of pharmacologic agents. Antifibrinolytics such as epsilon-aminocaproic acid, tranexamic acid, and aprotinin have been shown to reduce perioperative blood loss, autologous blood donation, transfusions, and associated costs in cardiac as well as major orthopaedic surgery. These agents reduce perioperative blood loss by inhibition of clot breakdown. Prospective, randomized studies have shown that the use of these agents can be effective in reducing the perioperative blood loss and transfusion requirements in total joint arthroplasty, pediatric scoliosis surgery, and adult reconstructive surgery of the spine. Aprotinin, however, is currently under suspension from use pending further evaluation of a trial. Although concerns exist about increased thrombotic events with the use of these agents, large meta-analyses suggest that antifibrinolytics can be safely and efficaciously employed to decrease perioperative blood loss and transfusion requirements.

Major Factors of Homologous Blood Transfusion in Valvular Heart Operation with Intraoperative Autologous Blood Predonation in Cases with Difficulty in Preoperative Predonation

Intraoperative autologous blood predonation is reported to be useful for the prevention of homologous blood transfusion in cardiac operations, especially in on-pump coronary artery bypass grafting (CABG). However, CABG is now performed more often off-pump than on-pump. We analyzed the major factors of homologous blood transfusion in 25 consecutive cases of valvular heart operation with intraoperative autologous blood predonation except those with preoperative autologous blood donation. Homologous blood was not transfused in 18 cases, but was in 7 cases only after cardiopulmonary bypass (CPB). The homologous transfusion was not correlated with body weight, CPB dilution or duration, or preoperative hematocrit level, but was found to correlate with age (R2=0.289, p=0.0413), bleeding output (R2=0.197, p=0.0485), and predonation blood volume (R2=0.436, p=0.0152). In conclusion, suitable intraoperative predonation may reduce the necessity for homologous blood transfusion in valvular heart operations.

Nonanemic Patients Do Not Benefit from Autologous Blood Donation Before Total Hip Replacement

To avoid the potential risks of allogeneic transfusion during total hip arthroplasty (THA), the use of preoperative autologous blood donation (PABD) has been utilized. We performed a retrospective chart review of 283 patients undergoing THA that either donated 1U of autologous blood (188 patients) or did not donate autologous blood before surgery (95 patients) in order to investigate the difference in postoperative transfusion rate (autologous and allogeneic), the incidence of allogeneic transfusion, and the difference in cost of each protocol. In addition, the study compared transfusion rates in patients with and without preoperative anemia (hemoglobin (Hb) ≤ 12.5g/dL). At 0.75 transfusions per patient versus 0.22 transfusions per patient, the PABD patients had a significantly higher overall transfusion rate. PABD significantly reduced the need for allogeneic blood in anemic patients (Hb ≤ 12.5g/dL) from 52.6% to 11.8%. PABD did not have the same affect in nonanemic patients (allogeneic transfusion rate 5.7% versus 4.0%). The study demonstrated that nonanemic patients undergoing THA do not benefit from PABD, but it is effective for anemic patients.

The Multimodal Approach for the Prevention of Thromboembolic Disease After Total Joint Arthroplasty

Total hip and knee arthroplasties carry an increased risk for thromboembolic disease. A multimodal prophylaxis protocol developed at the Hospital for Special Surgery and fully implemented since 1995, consists of stratifying the individual patient's risk and implementing a series of safe preventive measures before, during, and after surgery to reduce the risk of venous thromboembolism and bleeding. The measures include discontinuation of procoagulant medication and autologous blood donation before surgery; the use of hypotensive epidural anesthesia and intraoperative intravenous heparin after acetabular work during total hip arthroplasty; the use of pneumatic compression devices, elastic stockings, and frequent, vigorous dorsiflexion of the ankles; and prompt mobilization of the patient after surgery to diminish venous stasis. If these safe measures are observed, postoperative pharmacologic prophylaxis does not need to be aggressive in the patients without predisposing factors for venous thromboembolism and who mobilize promptly, thus diminishing the morbidity and mortality associated with the routine use of potent anticoagulants and the overall cost of care. Our clinical experience with close to 10,000 total hip and knee replacements demonstrates that this multimodal prophylaxis is safe and effective, resulting in a very low prevalence of thromboembolism, bleeding, and all-cause mortality.

Juzentaihoto (TJ-48), a traditional Japanese herbal medicine, influences hemoglobin recovery during preoperative autologous blood donation and after hip surgery

Preoperative autologous blood donation is a widely used alternative to allogenic transfusion in hip surgery. However, it has been reported that autologous blood donation may induce preoperative anemia. Juzentaihoto (TJ-48) (Tsumura Co., Tokyo, Japan) is a Japanese herbal medicine that has been used to alleviate anemia. We investigated the effect of TJ-48 on anemia in the perioperative period. 18 hips of 18 female patients who underwent total hip arthroplasty or rotational acetabular osteotomy (RAO) were divided into two groups. Group A consisted of 9 hips of 9 patients who were treated with TJ-48 at a dose of 7.5 g per day from 21 days before surgery to the day before surgery. Group B consisted of 9 hips of 9 patients who did not take TJ-48. Preoperative autologous blood donation was performed 21, 14 and 7 days before surgery. All patients deposited 400 ml each time for a total of 1,200 ml. Hemoglobin level was recorded on preoperative Days 21, 14 and 7 and postoperative Days 1, 4, 7 and 14. During the preoperative period, repeated measures ANOVA showed a significant difference between the two groups in hemoglobin level (p = 0.04). Despite the lack of TJ-48 after surgery, the rate of hemoglobin decline in Group A was less than in Group B at all examination times. No patients with TJ-48 experienced side effects, including gastrointestinal symptoms and unusual laboratory data. TJ-48 is useful for treating anemia during preoperative autologous donation.

Predicting the Risk of Perioperative Transfusion for Patients Undergoing Elective Hepatectomy

To develop 2 instruments that predict the probability of perioperative red blood cell transfusion in patients undergoing elective liver resection for primary and secondary tumors. Hepatic resection is the most effective treatment for several benign and malign conditions, but may be accompanied by substantial blood loss and the need for perioperative transfusions. While blood conservation strategies such as autologous blood donation, acute normovolemic hemodilution, or cell saver systems are available, they are economically efficient only if directed toward patients with a high risk of transfusion. Using preoperative data from 1204 consecutive patients who underwent liver resection between 1995 and 2000 at Memorial Sloan- Kettering Cancer Center, we modeled the probability of perioperative red blood cell transfusion. We used the resulting model, validated on an independent dataset (n = 555 patients), to develop 2 prediction instruments, a nomogram and a transfusion score, which can be easily implemented into clinical practice. The planned number of liver segments resected, concomitant extrahepatic organ resection, a diagnosis of primary liver malignancy, as well as preoperative hemoglobin and platelets levels predicted the probability of perioperative red blood cell transfusion. The predictions of the model appeared accurate and with good discriminatory abilities, generating an area under the receiver operating characteristic curve of 0.71. Preoperative factors can be combined into risk profiles to predict the likelihood of transfusion during or after elective liver resection. These predictions, easy to calculate in the frame of a nomogram or of a transfusion score, can be used to identify patients who are at high risk for red cell transfusions and therefore most likely to benefit from blood conservation techniques.

Combined Preoperative Autologous Blood Donation and Intra-Operative Cell Salvage for Hip Surgery

To review records of 161 consecutive hip surgery patients for whom preoperative autologous blood donation (PABD) was used in combination with intra-operative cell salvage (ICS). 114 women and 14 men aged 41 to 86 (mean, 64) years underwent 135 primary total hip arthroplasties (THAs), whereas 19 women and 7 men aged 16 to 52 (mean, 35) years underwent 26 rotational acetabular osteotomies (RAOs). Two or 3 weeks before the operation, patients deposited one unit (400 ml) of blood weekly, so long as their haemoglobin levels exceeded 110 g/l (if they had osteoarthritis) or 100 g/l (if they had rheumatoid arthritis). Patients were given oral ferrous sulphate, lactated Ringer's solution, and recombinant human erythropoietin. 800 and 1200 ml of blood were deposited for patients undergoing THA and RAO, respectively. Intra-operatively, ICS was carried out using a continuous autotransfusion system. The blood from ICS was transfused first, and then the blood from PABD was transfused during the latter half of the operation. By combining PABD and ICS, homologous blood transfusion was avoided in all patients, even in those with unexpected massive bleeding during surgery. In 3 patients, one unit of deposited autologous blood was discarded, because they showed no sign of anaemia. The mean total blood loss was almost 1.5 times higher in RAO than in THA patients (1095 vs 1550 ml). In the THA and RAO patients respectively, the mean amount of ICS was 181 and 210 ml, whereas the mean total blood transfusion volume was 975 and 1394 ml. No complications (including infection) related to autologous blood transfusion were observed during PABD, the surgery or the postoperative period. Homologous blood transfusion was avoided with the use of PABD and ICS. Preoperative donation of 800 and 1200 ml of blood (combined with ICS) seemed optimal, as only 3 units of blood were discarded.

Autologous Blood Donation for Apheresis of Peripheral Blood Hematopoietic Stem Cell in Low-Body Weight Children with Type 1 Diabetes.

Abstract 4194 BackgroudAutologous peripheral blood stem cells transplantation is widely used in treatment of malignant blood diseases, solid tumors and autoimmune diseases recently. Before apheresis, we filled the pipelines of Baxter CS-3000PLUS blood cell separator with the autologous blood instead of irradiated allogenetic blood. ObjectiveThe study is aimed to explore the safety and clinic efficacy of autologous blood donation for apheresis of stem cell in low body weight pediatric patients with type 1 diabetes. Method:There were three pediatric patients with type 1 diabetes in our hospital between August 2007 and December 2007. These patients included 2 male and 1 female with age of 5, 9, 9 respectively. Their weight was 15,18 and 23.5 kilograms respectively. Their blood test indexes were HB>120g/L,HCT>34%. On the 14th day before apheresis, 100ml autologous blood was collected and preserved in 4°C. Mobilization program was CTX 2g/m2 for 2 days and G-CSF 5∼10 μg/kg/d on the 5th day of before apheresis. Apheresis was initiated when WBC>5.0×109/L. SVSCH and SVCC were installed to blood cell separator at first. Before apheresis, we filled the pipelines of blood cell separator with the autologous blood instead of irradiated allogenetic blood. ResultOn the 9th day after the autologous blood donation, RBC ? AHB and HCT went back to the original level. In the process of apheresis.,every vital sign including blood pressure and heart rate was normal during apheresis. Hypotension or hyperthermia did not appear. The amount of CD34+ cell reached to 1.28-3.05×106/kg. ConclusionIt is concluded that autologous blood donation is a safe and an effective method to avoid allogenetic blood transfusion for apheresis of stem cell in low body weight pediatric patients. Disclosures:No relevant conflicts of interest to declare.

Preoperative autologous blood donation versus intraoperative blood salvage: intraindividual analyses and modeling of efficacy in 1103 patients

Preoperative autologous blood donation (PABD) and intraoperative blood salvage (IBS) represent established blood conservation measures. However, data comparing PABD to IBS are very sparse. We analyzed data from 1103 patients undergoing PABD and subsequent major orthopedic surgery in one center. We then used a validated model to compare PABD to IBS. We calculated maximal allowable blood losses (MABLs) for both IBS and PABD. We also identified criteria for efficacious use of either PABD or IBS. Our calculations were based on exclusive application of either technique, complete exhaustion of predeposited or salvaged blood, and one round of IBS. The vast majority of patients would have tolerated greater MABLs if subjected to IBS rather than PABD (425 of 432 with 1 PABD unit, 580 of 664 patients with 2 PABD units, 3 of 7 patients with 3 PABD units). For a few patients, however, our model demonstrated greater MABL with PABD than with IBS. These patients were characterized by 1) lower initial hematocrit (Hct), 2) recovery from PABD with return to baseline Hct or above by the time of surgery, and 3) longer time between first PABD and surgery. IBS appears to be the superior blood conservation technique if PABD cannot be performed under optimal conditions. Tolerable predonation anemia and sufficient time for regeneration appear to be crucial for post-PABD erythropoiesis. If these goals cannot be accomplished, PABD should be abandoned and be replaced by IBS.

Transfusion errors and their prevention

Although the current risks of acquiring viral transmission through blood components and products are very small, mistransfusion, in which a blood unit is incorrectly administered to a non‐designated recipient, remains the most common type of error in transfusion practice. ABO‐incompatible blood transfusion attributable to the incorrect identification (ID) of the patient or the blood unit is one of the most serious transfusion hazards. Many studies revealed that transfusion errors occur frequently in clinical areas, with the most common error being failure to perform the final patient ID check at the bedside. Thus, the pretransfusion bedside check is the most critical step for the prevention of mistransfusion. Machine‐readable ID technology, especially a bar code‐based ID system, is ideally suited to bedside check requirements. Our experience at the Juntendo University Hospital shows that the bar code‐based ID system has worked well over a 7‐year period on a hospital‐wide basis, and approximately 70 000 blood components have been transfused without a single mistransfusion. The overall rate of compliance with ‘second’ electronic bedside checking for blood components was 99%. Human error was the most frequent cause of errors leading to the failure of the bedside bar code ID check. The bar code‐based ID system has become applicable to the bedside pretransfusion check for paediatric transfusion, i.e. blood dispensed in syringes, and preoperative autologous blood donation, as well as regular allogeneic blood transfusion. If we want to reduce the risk of mistransfusion to improve transfusion safety, we have to address the issue at the hospital level, with a system‐based approach.

Duffy antigen expression on reticulocytes does not alter following blood loss in an autologous donation model

The Duffy blood group (Fy) antigen functions as the receptor whereby the malarial parasite Plasmodium vivax invades reticulocytes. In this study, we evaluated an autologous blood donation model to measure Fy expression during the anticipated response to blood loss. This study aims to examine Fy expression following anticipated reticulocytosis in response to blood loss from autologous whole blood donation. Subjects were healthy blood donors presenting for planned collection of two or three autologous units. Whole blood (450 ml +/- 10%) was collected and processed. Blood samples for Fy testing were obtained from the donations. These were assayed by flow cytometry by measuring binding of a phycoerythrin-labelled anti-Fy6 antibody and compared against reticulocyte numbers. Reticulocyte numbers were measured using thiazole orange. Results were compared from baseline (first donation) with samples at second and, if available, third, donations. Phenotyping for Fy a and b antigens was performed. Reticulocytes increased by a mean of 37% over baseline [0.93% (range 0.31-1.93) to 1.23% (0.32-3.51%)] following donation of two (n = 32) or three (n = 9) autologous whole blood units. Absolute reticulocyte count remained low. Mean and median Fy expression on mature red blood cells and reticulocytes did not change from baseline levels despite individual variation. No apparent relationship to serologically determined Fy a and/or b antigen status was present. Baseline expression of Fy antigen on mature red blood cells and reticulocytes is quite variable between individuals, but appears not to be greatly affected by mild to moderate reticulocytosis following blood loss in an autologous blood donation model.

Autologous blood donor screening indicated a lower prevalence of viral hepatitis in East vs West Germany: epidemiological benefit from established health resources

Prevalence data concerning viral hepatitis and human immunodeficiency virus (HIV) in the general population are usually scarce. We aimed for a large cohort representative of the general population that required little funding. Autologous blood donors are relatively representative of the general population, and are tested for viral hepatitis and HIV in many countries. However, frequently these data are not captured for epidemiologic purposes. We analysed data from well over 35,000 autologous blood donors as recorded in 21 different transfusion centres for anti-hepatitis C virus (HCV), HBsAg and anti-HIV, as well as TPHA if available. We found a lower prevalence of hepatitis B virus and HCV in East vs West Germany, 0.2%vs 0.32% and 0.16%vs 0.32% respectively, which confirms earlier data in smaller cohorts, thus supporting the value of our approach. HIV was too rare to disclose significant differences, 0.01%vs 0.02%. TPHA was higher in East (0.34%) vs West Germany (0.29%) without significant differences. HCV was more frequent in women vs men. Transfusion institutes managing autologous blood donations should be used as a resource for epidemiological data relating to viral hepatitis and HIV, if such testing is performed routinely. This approach generates data relating to the general population with special emphasis on undiagnosed cases.

Die Interdisziplinäre Arbeitsgemeinschaft für Klinische Hämotherapie – Startschuss für ein deutsches Hämovigilanzsystem

The German interdisciplinary task force for clinical hemotherapy (IAKH) is an independent association of clinicians. It aims for the improvement of blood transfusion application processes, procedures and safety in the absence of a German hemovigilance system. Whereas the producers of blood products concentrate on product safety, the IAKH focuses on administrative needs such as forms and regulations associated with the administration of blood products. It provides information about coagulation disorders, autologous blood donation and cell saving as well as techniques that reduce the amount of allogeneic transfusion needs. Benefits of a membership in IAKH are electronic and individual recommendations to clinical hemotherapy issues, an exchange forum, as well as low cost participation at conventions and meetings. Just recently, a critical incident reporting system for errors in blood transfusion and hemotherapy was launched (www.iakh.de/ BeinaheFehlerErfassung/). The entries reported are analyzed, feedback and recommendations are given. Everybody in contact with the administration of blood products is asked to report errors and critical incidents.

The Effect of Preoperative Recombinant Erythropoietin and Type of Surgical Procedure on Postoperative Hematocrit Following Orthognathic Surgery

Statement of the Problem: Significant blood loss and requirement for blood transfusion have regularly been cited as a risk of orthognathic surgery. Historically, patients provided preoperative autologous blood donation to prevent the risk of disease transmission. Many different surgical and anesthetic techniques have evolved to minimize the risks associated with, and the need for blood transfusions in orthognathic surgery patients. The purpose of this study was to evaluate the efficacy of a single preoperative dose of recombinant erythropoietin alpha (EPO) by comparing postoperative hematocrit and the rate of blood transfusion in healthy orthognathic surgical patients.

Intraoperative blood loss in bimaxillary orthognathic surgery with multisegmental Le Fort I osteotomies and additional procedures

Autologous blood donation is not currently recommended by most authors for routine bimaxillary osteotomies. There are few data about bimaxillary procedures with multisegmental maxillary osteotomies. Our aim was to investigate the effect of additional osteotomies and iliac crest grafts on operative blood loss. A total of 225 consecutive patients having bimaxillary multisegmental osteotomies during a three-year period (January 2006–January 2009) were examined to see if their haemoglobin concentration and packed cell volume were reduced. The influence of iliac crest grafts, additional osteotomies (genioplasty, malar osteotomy, iliac crest graft, anterior mandibular segmental osteotomy), operating time, age, and sex were assessed. Neither age nor sex influenced blood loss, whereas operating time correlated significantly with reductions in haemoglobin concentration and packed cell volume. Blood loss was significantly higher in the group who had additional procedures ( p 0.001 for haemoglobin concentration and packed cell volume) than in the group who had no additional procedures, whereas there were no significant differences among the three subgroups who had additional procedures (additional osteotomies, iliac crest grafts, or both procedures). Four patients who had additional procedures required transfusion, whereas no blood was given in the group who had no additional procedures. Because the transfusion rate was so low, we could make no general recommendation for preoperative blood donation in such cases.

Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study

Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed and the correlations between patient, operative variables, and blood loss were studied. In accordance with the recommendations of the Federal Medical Association and the Federal Ministry for Health and Social Security, a transfusion demand list was compiled using data of 82 patients who underwent bimaxillary orthognathic surgery between 1997 and 2005. The maximum blood loss tolerable without transfusion (MBL) was calculated for each patient on the basis of sex, weight, height, and preoperative hematocrit (Hct). This was compared with the actual transfusion and blood loss data. An autologous blood donation was carried out in 65 of 82 patients (79.3%). Sixty-two of 65 autologous blood donors (95.4%) and 2 of 17 patients (11.8%) without autologous blood donation received transfusion. The actual blood loss did not exceed the calculated MBL in 48 of the 82 cases. Nevertheless, 31 of these 48 patients (64.6%) received transfusions. For patients with a low calculated MBL, only a trend to a higher transfusion rate was observed, although the actual blood loss in these cases more often exceeded the individually calculated MBL (p < 0.01). In addition, transfusion triggers (Hct 0.22 or hemoglobin 7.5 g/dL) were also more often seen in cases with low calculated MBL (p < 0.05). In this study, an inappropriate transfusion practice in patients undergoing bimaxillary orthognathic osteotomies after preoperative autologous blood donation was detected. Calculation of the individual MBL should be used to help identify patients at high risk for transfusion and guide adequate methods to decrease the need of homologous blood.