Autologous Blood Donation Research Articles

Our experience of intraoperative autologous blood donation in patients undergoing elective valve surgery

Background Allogenic blood transfusions are associated with risks, costs, intermittent shortages, and questionable efficacy. Multiple alternatives have been advocated, and intraoperative autologous blood donation (IAD) or acute normovolemic hemodilution is one of these options.

Decreasing preoperative autologous blood donation: collaboration between a hospital and a blood center to prompt change in physician ordering behavior.

To describe the collaborative efforts of a large healthcare institution and its local blood center in reducing preoperative autologous blood donation (PABD). Through an educational letter-based campaign, we contacted physicians who historically had ordered PABD units. Follow-up educational efforts occurred at departmental and individual meetings. Our educational campaign to reduce PABD achieved complete elimination of PABD orders and the resultant waste of PABD units within 3 years of the start of the program. These changes were sustained for at least 2 subsequent years without the need for additional educational efforts. Targeted educational efforts directed at practitioners of PABD were successful in significantly decreasing the use and waste of PABD at the health care institution we studied and may yield the same results in comparable institutions.

Knowledge and attitude about blood donation and its subtype (autologous blood donation) among medical students in the Kingdom of Saudi Arabia

Introduction: Blood transfusion is a life-saving medical procedure. Autologous blood transfusion, which is also called self-donation, is the collection and reinfusion of the patient’ s own blood or blood components. It should be the transfusion therapy of choice, or at least, fully and carefully considered. Objectives: To test knowledge and attitude of medical students regarding blood donation and its subtype (autologous blood donation) in different colleges in the Kingdom of Saudi Arabia (KSA). Materials and methods: A cross-sectional study was conducted among 161 medical students, randomly selected from all years in different medical colleges in KSA. A web-based self-administrated, structured English questionnaire was used to test knowledge and attitude of medical students regarding blood donation and its subtype (autologous blood donation). The collected data were entered and analysed using IBM SPSS Statistics version 19 (IBM Corporation, Armonk, NY, USA). Results: Adequate knowledge about the blood vessels used for blood donation was present in only 68.0% of students. Complications of blood transfusion as a procedure and for the donor were known by 84% and 80% of students, respectively. Regarding autologous blood donation, 55% of students had not heard of it, 74% did not know its subtypes, 63% did not know about its benefits, 58% did not know that it is the safest method of blood donation, 53% of students refused to undergo this type of transfusion and 74% of students would not encourage others to use this method. Conclusions: Inadequate knowledge about blood donation, as well as autologous blood transfusion, is considered a serious problem among medical students who are future physicians. Recommendations include health campaigns to increase awareness in the community about blood donation and autologous blood transfusion, increase awareness about blood donation and autologous blood donation among medical students and increase the role of physicians in the city of Tabuk and KSA as whole to increase awareness about autologous blood transfusion in our society.

Predeposit autologous blood transfusion: Do we require to promote it?

Introduction: Safest blood a patient can receive is his own. Quest for safe blood transfusion has remained of prime concern. To meet this aspiration, various forms of autologous blood transfusions can be practiced. It is especially suitable for patients with rare blood groups and religious sects such as Jehovah's witness autologous transfusion is extremely safe. Cross matching is not required; iso-immunization to a foreign body is excluded. Fear of transfusion transmissible disease can be ignored. Therefore, autologous blood transfusion is required to be revisited. Materials and Methods: This is a prospective study carried out at Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune between July 2010 and May 2012. Study comprised of 100 patients divided into two groups, autologous and homologous. Benefits of autologous transfusion were studied. Results: There was no significant change in hematocrit and blood parameters after blood donation. That is mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration (P < 0.001) after blood donation. Only one complication of vasovagal syncope was observed at the time of blood donation. Conclusion: Autologous blood transfusion is safe. Easy alternative to be practiced in elective surgeries, especially in patients with rare blood group or believers of Jehovah's witness faith. It helps to reduce the shortfall in national blood inventory. Autologous blood donation should be practiced whenever possible.

Effect of Preoperative Autologous Blood Donation Coupled With Fluid Resuscitation on Transfusion Requirements Following Orthopedic Surgery

Background: Preoperative auto-blood donation has been shown to increase the likelihood of developing postoperative anemia following orthopedic surgery. This study was to assess the additive effect of intraoperative plus postoperative fluid resuscitation upon the relationship between preoperative donation and the frequency of postoperative transfusion. Methods: In this retrospective, single institution case-controlled study, hemoglobin levels, fluid administration, and incidence of transfusion were reviewed among 182 patients (91 donated blood preoperatively and 91 did not) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Results: Thirty-two (35.2%) donors and 18 (19.8%) non-donors received transfusion for adjusted risk of 2.817 (1.301 - 6.100) among donors versus non-donors. Donors are more affected by the hemodilution effects associated with fluid infusion and are transfused earlier and more frequently than non-donors. Conclusion: Preoperative autologous donation and fluid administration increase the risk for receiving postoperative transfusion. J Hematol. 2015;4(2):157-163 doi: http://dx.doi.org/10.14740/jh208w

Consensus and controversy in hepatic surgery: a survey of Canadian surgeons.

Heterogeneity in practice provides an opportunity for further study, as it may [IRT Rev 1] reflect deficiencies in knowledge translation or knowledge gaps. This survey aimed to assess practice patterns for the surgical treatment of malignancies of the liverwith the goal of identifying areas of variability. We created a web-based survey focusing on scope of surgical practice, pre-and post-operative measures and practice patterns for liver and biliary surgery. We piloted the survey for clarity and made changes as needed. All members of the Canadian Hepato-Pancreatico-Biliary Association (CHPBA) were invited to participate. Descriptive statistics were used to analyze the results. The survey was sent to sixty-nine surgeons and thirty-six (52%) completed the survey in its entirety. Areas of agreement include defining the resectability of a tumourand in imaging modalities used to determine resectability. Variability surrounded utlilization of blood conservation strategies, withlow CVP anesthesia frequently used and all other strategies (autologous blood donation, acute normovolemic hemodilution, cell-saver, and tranexamic acid) rarely used. Post-operative analgesic technique was variable with epidural analgesia (50%) and IV-PCA (35.3%) nearly equally preferred. There is variability in some techniques and approaches used by hepatobiliary surgeons. Future research focusing on areas of uncertainty including techniques of blood conservation and post-operative analgesia are needed.

Oral or parenteral iron supplementation to reduce deferral, iron deficiency and/or anaemia in blood donors.

Iron deficiency is a significant cause of deferral in people wishing to donate blood. If iron removed from the body through blood donation is not replaced, then donors may become iron deficient. All donors are screened at each visit for low haemoglobin (Hb) levels. However, some deferred blood donors do not return to donate. Deferred first-time donors are even less likely to return. Interventions that reduce the risk of provoking iron deficiency and anaemia in blood donors will therefore increase the number of blood donations. Currently, iron supplementation for blood donors is not a standard of care in many blood services. A systematic review is required to answer specific questions regarding the efficacy and safety of iron supplementation in blood donors. To assess the efficacy and safety of iron supplementation to reduce deferral, iron deficiency and/or anaemia in blood donors. We ran the search on 18 November 2013. We searched Cochrane Injuries Group Specialised Register, CENTRAL, PubMed, MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EBSCO Host) and six other databases. We also searched clinical trials registers and screened guidelines reference lists. Randomised controlled trials (RCTs) comparing iron supplementation versus placebo or control, oral versus parenteral iron supplementation, iron supplementation versus iron-rich food supplements, and different doses, treatment durations and preparations of iron supplementation in healthy blood donors. Autologous blood donors were excluded. We combined data using random-effects meta-analyses. We evaluated heterogeneity using the I(2) statistic; we explored considerable heterogeneity (I(2) > 75%) in subgroup analyses. We carried out sensitivity analyses to assess the impact of trial quality on the results. Thirty RCTs (4704 participants) met the eligibility criteria, including 19 comparisons of iron supplementation and placebo or control; one comparison of oral and parenteral iron supplementation; four comparisons of different doses of iron supplementation; one comparison of different treatment durations of iron supplementation; and 12 comparisons of different iron supplementation preparations.Many studies were of low or uncertain methodological quality and therefore at high or uncertain risk of bias. We therefore rated the quality of the evidence for our outcomes as moderate. There was a statistically significant reduction in deferral due to low haemoglobin in donors who received iron supplementation compared with donors who received no iron supplementation, both at the first donation visit after commencement of iron supplementation (risk ratio (RR) 0.34; 95% confidence interval (CI) 0.21 to 0.55; four studies; 1194 participants; P value < 0.0001) and at subsequent donations (RR 0.25; 95% CI 0.15 to 0.41; three studies; 793 participants; P value < 0.00001). Supplementation also resulted in significantly higher haemoglobin levels (mean difference (MD) 2.36 g/L; 95% CI 0.06 to 4.66; eight studies; 847 participants, P value =0.04), and iron stores, including serum ferritin (MD 13.98 ng/mL; 95% CI 8.92 to 19.03; five studies; 640 participants; P value < 0.00001) and transferrin saturation (MD 3.91%; 95% CI 2.02 to 5.80; four studies; 344 participants; P value < 0.0001) prior to further donation. The differences were maintained after subsequent donation(s).Adverse effects were widely reported and were more frequent in donors who received iron supplementation (RR 1.60; 95% CI 1.23 to 2.07; four studies; 1748 participants; P value = 0.0005). Adverse effects included constipation, diarrhoea, nausea, vomiting and taste disturbances, and some participants stopped treatment due to side effects. There is moderate quality evidence that rates of donor deferral due to low haemoglobin are considerably less in those taking iron supplements compared with those without iron supplementation, both at the first donation visit and at subsequent donation. Iron-supplemented donors also show elevated haemoglobin and iron stores. These beneficial effects are balanced by more frequent adverse events in donors who receive iron supplementation than in those who do not; this is likely to limit acceptability and compliance. The long-term effects of iron supplementation without measurement of iron stores are unknown. These considerations are likely to preclude widespread use of iron supplementation by tablets. Blood services may consider targeted use of supplementation in those at greatest risk of iron deficiency, personalised donation intervals and providing dietary advice.

The impact of blood management on length of stay after primary total knee arthroplasty.

The current study investigates the impact of patient factors, surgical factors, and blood management on postoperative length of stay (LOS) in 516 patients who underwent primary total knee arthroplasty. Age, gender, type of anticoagulation, but not body mass index (BMI) were found to be highly significant predictors of an increased LOS. Allogeneic transfusion and the number of allogeneic units significantly increased LOS, whereas donation and/or transfusion of autologous blood did not. Hemoglobin levels preoperatively until 48 hours postoperatively were negatively correlated with LOS. After adjusting for confounding factors through Poisson regression, age (p = 0.001) and allogeneic blood transfusion (p = 0.002) were the most significant determinants of LOS. Avoiding allogeneic blood plays an essential role in reducing the overall length of stay after primary total knee arthroplasty.

Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion.

We retrospectively studied 108 marrow harvests from 105 pediatric sibling donors. The median age of donors was 8 years (range: 1-15) and the median body weight was 27 kg (range: 10-100). The volumes of aspirated marrow were 5.0-23.8 mL/kg donor body weight, and harvested bone marrow volume exceeded 15 mL/kg in 42% of the donors. A total of 100 autologous blood donations were performed, and eight donors had red cells salvaged from their harvests reinfused. The median Hb levels before and after harvests were 12.3 g/dL (range: 10.0-14.7) and 11.0 g/dL (range: 8.9-13.8), respectively. None of the donors received allogeneic blood transfusions or hematopoietic growth factors such as EPO and G-CSF before or after collection. Transplanted dose was 1.4-10.8 × 10(8) cells/kg recipient body weight without differences due to donor age. Higher concentrations of nucleated and CD34(+) cells were obtained from younger donors. All donors tolerated the procedures well, with no serious complications. Thus, children may safely donate marrow for allogeneic transplantation, and the yields of nucleated cells for engraftment are substantial.

Safety and efficacy of preoperative autologous blood donation for high-risk pregnant women: experience of a large university hospital in Japan.

Preoperative autologous blood donation (PAD) has the advantages over allogeneic blood transfusion of theoretically no risk of viral infection and alloimmunization. However, there are some concerns regarding PAD in pregnant women, as they sometimes become anemic and adverse effects such as low blood pressure could be harmful to fetuses. In our hospital, the PAD program was implemented in 2006 and has been used in pregnant women at high risk of massive hemorrhage. In this study, the safety of PAD in pregnant women and its efficacy for avoiding allogeneic blood transfusion were investigated. The hospital records of pregnant women who delivered at our hospital from January 2009 to June 2012 were reviewed and those who were enrolled in the PAD program for predicted massive hemorrhage were analyzed. Among the total of 3095 deliveries, 69 cases enrolled in the PAD program were analyzed. Blood donation was performed 189 times for the 69 cases. The median donated blood volume was 1200 mL (range, 400-2000). The mean blood loss during delivery was 1976 ± 1654 mL. Autologous blood was transfused in 64 cases. Allogeneic blood transfusion was required in five cases of massive blood loss exceeding 5000 mL. In the other 64 cases, no additional allogeneic blood transfusion was required. No adverse events were observed in either the pregnant women or fetuses. For pregnant women at a high risk of massive hemorrhage, our PAD program was safe and effective for avoiding allogeneic blood transfusion.

Pregnancy outcomes after emergent laparoscopic surgery for acute adnexal disorders at less than 10 weeks of gestation

To report our experience with pregnancy outcomes after emergent laparoscopic surgery for acute adnexal disorders at less than 10 weeks of gestation when surgical intervention could be more invasive to intrauterine pregnancy. Gasless multiport laparoscopic surgery or transumbilical laparoendoscopic single-site surgery was performed with securing of the surgical view by the abdominal wall-lift method. Intraoperative autologous blood salvage and donation was performed in cases associated with significant hemoperitoneum. Six cases of ovarian bleeding with ruptured corpus luteal cyst, three cases of adnexal torsion with corpus luteal cyst, and one case each of ruptured heterotopic ampullary pregnancy and heterotopic tubal stump isthmic pregnancy after salpingectomy were managed. For ruptured corpus luteal cyst, hemostasis was achieved by removal of hematoma followed by suturing. For adnexal torsion, detorsion with cyst aspiration was performed in two cases and detorsion alone was performed in one case. For ruptured heterotopic ampullary pregnancy, unilateral salpingectomy was performed. For ruptured heterotopic tubal stump isthmic pregnancy after salpingectomy, removal of the expelled villous tissue followed by hemostatic coagulation was performed. In five cases associated with massive hemoperitoneum, intraoperative autologous blood salvage and donation were performed to avoid homologous blood transfusion. After surgery, seven live births were achieved, while two cases of biochemical pregnancy loss and a case of complete miscarriage were noted. Although miscarriage could be a significant concern in the perioperative period, gasless laparoscopic surgery appeared to be feasible for management of acute adnexal disorders at less than 10 weeks of gestation.

Impaired autonomic regulation in hyperglycemia and cardiovascular dynamics during autologous blood donation (1072.7)

Hyperglycemia has been reported as a risk factor for autonomic dysfunction. However, the changes in autonomic nerve activity that occur in hyperglycemic patients during blood volume reduction are unclear. This study aimed to investigate the impact of hyperglycemia (HbA1c 蠅 6.5%) on autonomic nerve activity and cardiovascular dynamics during blood volume reduction (300‐400 mL), by using autologous blood donation as a model of mild blood loss.We compared the impact of hyperglycemia and non‐hyperglycemia on heart rate variability, including circulatory regulation, in 17 patients (mean age 60.9 ± 13.6 years) with no circulatory, respiratory, or cranial nerve disease.During autologous blood donation, none of the patients experienced significant changes in blood pressure or heart rate. In non‐hyperglycemia, the low frequency/high frequency component ratio (LF/HF) significantly increased (p &lt; 0.05) and HF decreased during autologous blood donation. In hyperglycemia, LF/HF and HF responses were lower than in non‐hyperglycemia.These results show that hyperglycemia impaired autonomic regulation during a blood volume reduction of approximately 10% of the circulatory blood volume. This suggests that circulatory failure may be more common in hyperglycemic patients than in non‐hyperglycemic patients during moderate or severe blood volume reduction.

Morbidity and mortality after autotransfusion following open heart surgery

BackgroundThe technique of ‘blood pooling’ before the onset of cardiopulmonary bypass (CPB) has been shown to be beneficial as a single technique in patients having elective open heart surgery. We sought to more clearly evaluate the role of intra-operative autologous donation also known as acute normovolemic haemodilution in open heart surgery.MethodsThe study was conducted in the Department of Cardiothoracic and Vascular Surgery, King George’s Medical University, Lucknow, India, in patients who underwent open heart surgery under cardiopulmonary bypass. Autologous blood transfusion was used in all the patients who underwent surgery on CPB since August 2009. Patients were divided into two groups: group I (study group)—patients operated between August 2009 and December 2011 and who received autologous blood and group II (control)—those operated before August 2009 and who did not receive autologous blood transfusion.ResultsThe post-operative haemoglobin and coagulation profile measured on the first post-operative day differed significantly between the two groups. Intensive care unit (ICU) stay, hospital stay, inotropic support and ventilatory support were significantly less in group 1. Mediastinal drainage was found to be significantly higher in the control group compared to the study group. The mean volume of packed red blood cell, fresh frozen plasma and platelet units transfused per patient in the study group were significantly less than the control group.ConclusionThe use of intra-operative autologous blood donation and transfusion improves haemostasis, decreases the post-operative blood loss and improves the post-operative outcome in terms of intensive care unit stay, hospital stay, morbidity and mortality.

The Relative Risk of Infection from Transfusions After Arthroplasty

For more than a quarter century, orthopaedic surgeons and their patients have been plagued with heightened concerns over complications from blood transfusions. The initial cause for increased caution, starting in the mid-1980s, was the increased awareness of bloodborne transmission of retroviral disease in the form of human immunodeficiency virus (HIV) and the new, near-concurrent ability to identify Hepatitis C separately from Hepatitis A and B1. The sense of burgeoning epidemics of both diseases and the incomplete ability of screening to prevent their transmission led to a new willingness to avoid transfusions at progressively lower hematocrits as well as an explosion of enthusiasm for preoperative autologous blood donations. A second cause for concern, which grew more slowly over the next decade, was that of transfusion-related immunomodulation. Direct clinical measurements of components of the immune system being suppressed by allogeneic blood exposure have been demonstrated; these measurements have been coupled, mostly outside of the orthopaedic literature, with clinical reports of increased rates of infection and more frequent recurrence of tumors2. The most immediate concern for orthopaedic surgeons was the question of increased risk from transfusion for infections after insertion of prosthetic implants. Despite the frequent invocation of such risk as a reason to delay transfusion, the arthroplasty-specific literature has been varied and relatively underpowered on this question. As pointed out by Friedman et al. (one of the two articles discussed in this commentary), the articles that did address this question clinically have been single-center studies compromised by small patient group sizes. In this edition of The Journal, two articles with large patient groups are published that specifically address the question of transfusion-related immunomodulation and the risk for infection after total joint arthroplasty. The issue of sufficient statistical power was addressed in each article by taking advantage of two …

Blood Conservation

Blood Conservation

Rationale use of blood and its components in obstetric-gynecological practice

Appropriate and rational use of blood/components is essential for ensuring availability for the needy as well as preventing risks of transfusion-transmitted diseases and saving resources. Rational use means providing the right blood or products, in the right quantity, to the right patient and at the right time, bridging demand, and supply gap. The safety, adequacy, and effectiveness can only be achieved if unnecessary transfusions can be prevented. Further, risk can be reduced, but cannot be eliminated completely. Alternative to banked blood, autologous blood donation, normovolemic hemodilution, and intraoperative cell salvage should be considered as possible options. Recombinant factor VIIa is a new adjunct for treatment of massive hemorrhage and should be considered, if available.

Assess influence of preoperative autologous blood donation on total knee arthroplasty

Assess influence of preoperative autologous blood donation on total knee arthroplasty

Allogeneic peripheral blood stem cell transplantation for an acute myeloid leukemia patient with a rare Rh-variant D-- phenotype

We here report a rare case of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for an acute myeloid leukemia (AML) patient with the Rh-variant D phenotype. People whose red blood cells (RBCs) have a rare deleted Rh phenotype (D ) readily produce anti-Rh17 alloantibodies (an antibody to the RhCc/Ee protein). This causes clinical complications resulting from RBC destruction due to the interaction of alloantibodies with RBCs carrying the corresponding antigen. Consequently, patients with such variants who have formed alloantibodies pose a challenge for transfusions given the scarcity of compatible donors. In fact, in Japan, only 1 in 200,000 individuals are eligible donors. A 26-year-old male AML patient underwent allo-PBSCT from an HLA-matched sibling donor. He had the rare D phenotype and developed anti-Rh17 alloantibodies before allo-PBSCT. Given the scarcity of compatible blood donors for transfusions, the patient required autologous blood donations in preparation for allo-PBSCT. RBC engraftment was prompt during allo-PBSCT; thus, no unscheduled RBC blood transfusion was required. Five months later, his blood type changed to that of his sibling donor, and no irregular antibodies to RBCs were detected. (Journal of Hematopoietic Cell Transplantation 3(3): 93-96, 2014.)

待機心臓手術における術前自己血貯血の実態調査

待機心臓手術における術前自己血貯血の実態調査

Pre-operative blood donation versus acute normovolemic hemodilution in cardiac surgery.

Introduction:Acute normovolemic hemodilution (ANH) and preoperative autologous blood donation (PABD) have questionable efficacy, viral and bacterial infection risks, intermittent blood shortages as homeostasis problem, electrolyte and hemodynamic disturbances.Materials and Methods:In this cross sectional survey, we studied 70 patients undergoing open heart coronary artery bypass grafts [CABG] and different valvular replacement 1 ml surgery (35 in ANH, 35 in PABD) in Shaheed Modares - Hospital. We measured electrolytes and homeostatic factors to evaluate the influence of two transfusion methods on homeostatic function and hemodynamic balance.Results:We compared 70 patients (38 male [54.3%] and 32 female [45.7%]) with mean age 54.8 years undergoing open heart surgery (CABG and valvular). In ANH group, significant decrease was detected in Na (28.5%) K (2.5%), prothrombin time (PT) (88.57%), partial thromboplastin time (PTT) (94.28%), creatine phosphokinase (CPK) (11.4%), lactic dehydrogenase (LDH) (11.43%), albumin (Alb) (17.14%), globulin (91.43%) and total protein (80%). Mean initial and post-operative hemoglobin was 14.12 ± 1.06 versus 11.97 ± 0.98, hematocrit 42.22 ± 3.45 versus 35.40 ± 2.88, systolic blood pressure 124.1 ± 14.4 versus 110.88 ± 15.6 (reduction 22.86%) diastolic blood pressure 76.02 ± 10 versus 69.26 ± 11 (reduction 3%) and pulse rate was 75.45 ± 10 versus 84.45 ± 12 (12%) in this case difference between two groups was strongly significant (P = 0.001). In PABD group, significant decrease was detected in Na (20%), K (2.5%), PT (91.43%) PTT (80%), CPK (8.57%), LDH (5.72%), Alb (57.15%), globulin (71.43%) and total-protein (62.85%), the value of hemodynamic changes were in normal range.Conclusion:Though autologous blood transfusion (ANH and PABD) was preferable to allogeneic transfusion in cardiac surgical patients; but PABD offers more advantages in homeostasis, hemodynamic stability and electrolyte balance.