Autologous Blood Donation Research Articles

PMS16 Potential Cost Saving of Epoetin Alfa Compared to Autologous Blood Donation or to No-Blood-Conservation-Strategy Before Elective Hip or Knee Surgery Due to reduction in Allogeneic Blood Transfusions and Its Side Effects

PMS16 Potential Cost Saving of Epoetin Alfa Compared to Autologous Blood Donation or to No-Blood-Conservation-Strategy Before Elective Hip or Knee Surgery Due to reduction in Allogeneic Blood Transfusions and Its Side Effects

Autologous blood in obstetrics: where are we going now?

In developed countries1, pregnancy-related transfusion accounts for about 6 percent of red blood cell (RBC) units transfused. This means that, for example, in the UK as a whole, approximately 70,000 units of RBC are transfused to obstetric patients each year2. The pattern of blood usage is very different in countries in which diagnostic and treatment options are more limited, with 37 percent of transfusions being given to women with obstetric emergencies1. Obstetric haemorrhage is a leading cause of maternal and perinatal mortality3. Placental abruption and placenta praevia/accreta can present as antepartum haemorrhage and are risk factors for post-partum haemorrhage (PPH). Uterine atony, inversion, retained products of conception and genital tract trauma all cause PPH and account for the majority of cases of major haemorrhage. Uterine rupture is an infrequent cause of haemorrhage and maternal death and can occur spontaneously or at the site of previous uterine surgery (caesarean section or retained placenta)3. During the triennium 2006–2008, the rate of deaths from hemorrhage in the UK was 0.39 per 100,000 maternities4. The incidence of severe bleeding in childbirth has been estimated in various surveys and is approximately one in 200 to 250 deliveries4. In developed countries treatment is generally effective with an approximate case fatality rate between 1 in 600 to 800 cases of obstetric bleeding5–7. Various blood conservation techniques can reduce exposure to allogeneic blood. These include pre-operative autologous blood donation (PABD), acute normovolaemic haemodilution (ANH) and intra-operative blood salvage (IBS). PABD may cause anaemia, does not eliminate transfusion risk, cannot be used in an emergency, is not acceptable to Jehovah’s Witnesses and should be reserved for exceptional circumstances8,9. ANH may induce anaemia and cardiac failure, cannot be used in an emergency and may have a limited role in combination with other techniques9. The use of IBS has increased substantially during the last two decades and the re-infusion of shed washed blood is commonplace in many types of surgical operations in which heavy blood loss is anticipated10,11. In this technique, blood shed at the time of surgery is collected and washed, and RBC are returned to the patient as an ongoing process (Figure 1)12,13. In skilled hands, blood salvage can be quickly set up and the final product returned to the patient within minutes of collection. In addition, this technique is also acceptable to some Jehovah’s Witnesses, provided the equipment is set up in continuity with the circulation (Figure 1)14, but consent needs to be obtained on an individual basis. Figure 1 Schematic representation of a blood salvage system with a double suction setup to reduce the possible contamination of the blood suctioned from the surgical field138. In this setup, one suction line is connected to the collection reservoir and used for ... However, the safety of IBS in obstetrics has been questioned and its introduction in this clinical arena has been delayed because of theoretical concerns stemming from the historical and ongoing dispute focused on the risk of maternal-foetal anti-Rh(D) alloimmunisation and the risk of contamination of the cell-saved blood with traces of amniotic fluid (AF)15,16. The objective of this article is to review the role of autologous blood conservation techniques in obstetrics focusing on the currently available evidence regarding IBS. An overview of current European regulatory requirements on IBS will also be provided.

Pattern of Blood Donors in Jos.

Background: Blood donors are categorized into voluntary, paid, family replacement, autologous, directed and therapeutic. Superior safety has long been identified with voluntary and autologous blood donations. The setting up of the centralized blood transfusion service centre is to source blood from prospective voluntary donors among other responsibilities. AIM: To determine the types of blood donors received at the blood transfusion service and make appropriate suggestion towards transfusion safety. Methods: We reviewed blood donor records from April 2008 to March 2010 for the pattern of blood donors received at the north central blood transfusion service centre of the National blood Transfusion Service, Jos. Results: A total of 7286 donors were recruited in the transfusion centre and in hospital blood banks. 78.2% were voluntary donors while 21.7% were family replacement donors all from hospital blood banks. Conclusion: The high rate of voluntary blood donation recorded in the transfusion service is a departure from the culture of replacement donation experienced in hospital blood transfusion units. This portrays a ray of hope towards the attainment of 100% voluntary blood donation and its attendant safety. We recommend improved commitment of resources from government and donor agencies in this regard. State and local governments should establish transfusion units to collaborate with the National Blood Transfusion Service of Nigeria.Key words: Voluntary, Replacement Donors, Transfusion Service.

Patient Blood Management

Globally, more than 81 million units of red blood cells are transfused annually. Of the 15 million red blood cell components transfused annually in the United States, approximately 40% are transfused to patients undergoing elective surgical procedures. Because of concerns about limited blood availability as well as risks of transfusion-related adverse events, blood products should be used judiciously. Using the case of Ms C, a 68-year-old woman considering autologous blood donation prior to knee replacement surgery, the concept of patient blood management is discussed. This approach entails a complete evaluation of the patient in the preoperative period to assess for bleeding risks and anemia, with a goal to optimize a patient's condition prior to surgery; use of various strategies in the operative period to mitigate the need for allogeneic blood transfusion; and meticulous postoperative care to again avoid the need for blood transfusion.

Preoperative Autologous Blood Donation Results in More Transfusions in the Surgical Treatment of Adolescent Idiopathic Scoliosis

Preoperative Autologous Blood Donation Results in More Transfusions in the Surgical Treatment of Adolescent Idiopathic Scoliosis

Two different dosing regimens of human recombinant erythropoietin beta during preoperative autologous blood donation in patients having hip arthroplasty

Our aim was to evaluate the effectiveness of two different dosing regimens of human recombinant erythropoietin (rHu-EPO) for preoperative autologous blood collection in patients undergoing total hip arthroplasty (THA). Prospective randomised trials in which erythropoietin 15,000 IU was administered intravenously twice a week or 30,000 IU once a week (total 90,000 IU) combined with ferrous II sulphate (Ferro-Gradumet 2) orally and compared with Ferro-Gradumet 2 alone. Although different dosing regimens of rHu-EPO administration during preoperative autologous blood donation have similar effects on the collection of two units of autologous blood, preoperative haemoglobin level and perioperative allogenic blood transfusion, a once weekly dose regimen of rHu-EPO was more convenient (although not statistically significantly) for patients. We recommend the more practical and comfortable but yet highly effective therapeutic regimen with a single weekly intravenous administration of rHu-EPO for patients scheduled for THA.

Five‐year study assessing the feasibility and safety of autologous blood transfusion in pregnant Japanese women

To assess the feasibility and safety of autologous blood donation during pregnancy in Japanese women. We enrolled patients who were either at high risk for massive blood loss during delivery or had blood that was difficult to match for transfusion between March 2005 and February 2010. After delivery, we reviewed hospital records of these patients to collect data on blood donation procedures, obstetric outcome and blood transfusions received. We enrolled 314 patients during the study period and performed 809 blood donations. The median volume of donated blood was 1200 mL (range, 400-2000 mL). Vasovagal reflex as an adverse donor reaction occurred in 10 of the 314 patients (3.2%) during 11 of the 809 donations (1.4%). There were no cases of non-reassuring fetal heart rate patterns during blood donations. Twenty-five (7.8%) of the 322 neonates were admitted to the neonatal intensive care unit. All 322 infants were healthy 1 month after delivery. Among 314 patients, autologous blood re-transfusion was performed for 56 (17.8%) and homologous blood transfusion was performed concurrently for 5 (1.6%). Placenta previa was the indication with the highest re-transfusion rate (42.4%). All re-transfusions were performed without side-effects. Autologous blood donation is feasible and safe for pregnant women and their infants. Although indications of autologous blood donation are controversial, it should be considered for cases of placenta previa.

Nonanemic Patients Do Not Benefit from Autologous Blood Donation before Total Knee Replacement

A retrospective analysis of 221 patients undergoing unilateral total knee arthroplasty between January 2007 and April 2008 was performed to look at rates of total transfusions, allogenic transfusions, and autogenic transfusions. Two senior surgeons performed all the surgeries. During that period, patients in group A (129 patients) all donated one unit of autologous blood and patients in group B (92 patients) did not donate. Within both groups, patients were further divided by preoperative hemoglobin level as either anemic or non-anemic. A hemoglobin of 12.5g/dL was used as the cutoff. Ninety-eight patients in group A (76%) required autologous blood. Patients in group A received a higher total number of transfusions (0.93 per patient) than those in group B (0.33 per patient; p < 0.001). The rate of allogenic transfusion was lower for group A (14%) than for group B (25%; p < 0.033). The reduction of allogenic transfusions associated with preoperative autologous blood donation was confined to anemic patients (29% in group A vs 72% in group B; p = 0.0006). There was no difference in allogenic blood transfusions in non-anemic patients between group A (8%) and group B (9%; p = 0.91). Limiting autologous blood donation to anemic patients decreased cost compared to routine autologous blood donation (US $256.63/patient versus US $511.44/patient) without exposing patients to increased allogenic blood transfusions. Targeted blood management in total knee replacement surgery decreases transfusion rates and reduces cost.

Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery

Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

Bombay Blood Type and Use of Red Cell Apheresis During Pregnancy

Bombay blood type is among the rarest in the world and is associated with anti-H antibodies. These antibodies cause severe hemolysis when exposed to any blood product except Bombay and have been reported to cause hemolytic disease of the newborn. A primigravid woman with Bombay blood type received erythropoietin and underwent autologous blood donation using red cell apheresis. Maternal anti-H immunoglobulin G antibodies were identified and serial evaluation of the middle cerebral artery peak systolic velocity was used to monitor for fetal anemia. Hemolytic disease of the newborn did not develop. Red cell apheresis is a valuable procedure that results in two units of red blood cells per donation and was well tolerated during pregnancy.

Pre-operative autologous blood donation: clinical parameters and efficacy.

Pre-operative autologous blood donation (PABD) aims to provide a supply of safe blood for patients undergoing surgery who might need a blood transfusion while at the same time increasing the patient's total red blood cell (RBC) mass due to the PABD-induced stimulation of erythropoiesis before scheduled elective surgery. This can, however, only be accomplished if the determinants of RBC regeneration are understood. The improvement of viral safety of allogeneic blood products following the introduction of molecular techniques has led to a decline in the use of autologous blood conservation (ABC) measures, and in particular in the use of PABD. More rational and restrictive indications for allogeneic blood transfusion have evolved and led to a further decrease in the relevance of PABD.

Transfusion therapy in the peri-operative period.

Transfusion therapy in the peri-operative period.

Autologous Blood Donation Programs in Surgical Correctionof Spinal Scoliotic Deformity

Objective. To develop the programs of autologous blood deposition to compensate blood loss in surgical correction of spinal deformity. Material and Methods. The study included 145 patients with spinal deformities who underwent one- and two-stage selective surgical interventions. In the study group (n = 100) autologous blood components were preoperatively deposited for intra- and postoperative blood loss compensation; in the control group (n = 45) prior deposition was not performed. Results. It was found that, taking into account the terms of autologous blood shelf life and efficacy, a prior deposition of 20 % of total blood volume (TBV) providing compensation of blood loss up to 40–45 % of TBV is optimal for one-stage surgical intervention, and deposition of 30 % of TBV allowing loss compensation of 50–55 % of TBV is enough for twostage surgery. Conclusion. Autologous blood deposition is an effective method for blood loss compensation. Blood deposition volume and techniques are determined by an expected blood loss associated with specific surgical intervention.

Development and validation of a production process of platelet lysate for autologous use

Growth factors (GF) contained in platelets are a potential source to improve wound healing by the stimulation and acceleration of soft tissue and bone healing. This resulted in the idea that autologous platelet-rich plasma or platelet lysate (PL) containing high levels of GF might improve healing processes. Today platelet products are already applied in bone and maxillofacial surgery. In recent years, cosmetic surgery and facial rejuvenation procedures are growing steadily. New methods including platelet products aiming to induce non-surgical reduction of wrinkles upon topical injection and to minimize surgical risks in general are developed. Several point-of-care devices are already available on the market. However, the amount of PL obtained by these kits is far too high for certain applications in cosmetic surgery and they offer no possibility of storing the remaining material in a sterile manner. Therefore we developed a procedure for the sterile production of smaller amounts of PL in a closed system that can also be split into several products for repeated administration. The closed system was determined to be a bag system designed for an autologous blood donation of 100 ml whole blood. We set a special focus on the validation of the production procedure, mainly regarding sterility and platelet recovery. For validation 22 healthy volunteers were asked for a blood donation, which was centrifuged twice to obtain concentrated platelets (CP). A freeze–thaw cycle caused lysis of the CP to get approximately 8.48 ± 1.36 ml PL. We yielded satisfying results of 100% sterility and a platelet recovery of 36.92% ± 18.71%. We therefore conclude that the PL obtained is ready for studies comparing it with traditional treatments.

Blood transfusion risks and alternative strategies in pediatric patients

Although the safety of the blood supply has been greatly improved, there still remain both infectious and noninfectious risks to the patient. The incidence of noninfectious transfusion reactions is greater than that of infectious complications. Furthermore, the mortality associated with noninfectious risks is significantly higher. In fact, noninfectious risks account for 87-100% of fatal complications of transfusions. It is concerning to note that the majority of pediatric reports relate to human error such as overtransfusion and lack of knowledge of special requirements in the neonatal age group. The second most frequent category is acute transfusion reactions, majority of which are allergic in nature. It is estimated that the incidence of adverse outcome is 18:100,000 red blood cells issued for children aged less than 18 years and 37:100,000 for infants. The comparable adult incidence is 13:100,000. In order to decrease the risks associated with transfusion of blood products, various blood-conservation strategies can be utilized. Modalities such as acute normovolemic hemodilution, hypervolemic hemodilution, deliberate hypotension, antifibrinolytics, intraoperative blood salvage, and autologous blood donation are discussed and the pediatric literature is reviewed. A discussion of transfusion triggers, and algorithms as well as current research into alternatives to blood transfusions concludes this review.

Early experience with isobaric laparoendoscopic single-site surgery using a wound retractor for the management of ectopic pregnancy

ObjectiveTo report our initial experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery using a wound retractor for the management of ectopic pregnancy. Study designTwelve consecutive cases of ectopic pregnancy were managed by isobaric LESS surgery with the subcutaneous abdominal wall-lift method. In each case, a wound retractor was used as a transumbilical working port with insertion into the peritoneal cavity through a 2.5-cm vertical umbilical incision. Subsequent surgical procedures were performed with multiple conventional laparoscopic instruments through single umbilical port. ResultsAll cases of ectopic pregnancy were successfully managed by isobaric LESS surgery. Procedures included salpingectomy in eight cases of ampullary pregnancy and two cases of isthmic pregnancy, salpingectomy and local methotrexate injection in one case of isthmic pregnancy, and salpingo-oophorectomy for one case of ovarian pregnancy. Neither extraumbilical incisions nor conversion to laparotomy was required. In a case of ruptured ampullary pregnancy with massive hemoperitoneum, intraoperative autologous blood salvage and donation avoided the need for the transfusion of bank blood. Although postsurgical umbilical seroma was noted in one case and systemic methotrexate administration was required for persistent ectopic pregnancy in one case of isthmic pregnancy respectively, there were no major surgical complications in this series. The technique yielded excellent cosmetic results with minimum postoperative scar concealed within umbilicus. Retrospective comparison of surgical parameters including surgical duration, estimated blood loss, frequency of postoperative analgesic use, time of bowel recanalization, postoperative inflammatory response and postoperative hospital stay did not show any significant differences between isobaric LESS surgery group and conventional isobaric multiport laparoscopic surgery group. ConclusionsBased on the satisfactory outcome achieved in these initial 12 cases of ectopic pregnancy treated by isobaric LESS surgery, the wound retraction system combined with the subcutaneous abdominal wall-lift method appears to contribute favorably to LESS surgery for the management of ectopic pregnancy because the device permits free circumferential access and retraction during procedures without the closed condition required during pneumoperitoneum.

Efficient strategy for controlling postoperative hemorrhage in total knee arthroplasty

PurposeThe objective of the present study was to compare the intraoperative use of tranexamic acid (TNA) plus intra-articular diluted-epinephrine (DEP) with preoperative autologous blood donations and transfusions in reducing an allogeneic blood transfusion (ABT) in primary unilateral total knee arthroplasty (TKA).MethodsPatients (n = 133) treated with unilateral primary TKA were divided into three groups retrospectively: patients administered autologous blood transfusions were assigned to group A (n = 51); patients administered preoperative injections of TNA and postoperative intra-articular injections of DEP were assigned to group B (n = 42); and patients treated with the drain-clamp method in addition to injections of TNA and DEP were assigned to group C (n = 40). The rate of avoidance of ABTs, postoperative blood loss, and complications (DVT/PE, skin problems) were examined.ResultsThe differences among the three groups were not significant in terms of the proportion of patients requiring no ABTs (94% in group A, 93% in group B and 95% in group C, n.s.). The total blood loss calculated was 1,140 ± 451 ml, 852 ± 343 ml, and 850 ± 296 ml, respectively (group B > A, group C > A, P = 0.0009). The significant complications were not observed in three groups.ConclusionThe results of the study showed that the TNA plus DEP combination exerted a comparable effect with preoperative autologous blood transfusion in avoiding ABTs in unilateral primary TKA. Considering several problems of preoperative autologous blood donation, the use of TNA plus DEP is recommended. In addition, it is highly possible that allogeneic blood transfusions can be avoided for patients with preoperative Hb values ≥10.5 using the method described in this study, and the need for preoperative autologous blood donations can be decreased.

Laboratory characteristics and clinical utility of post-operative cell salvage: washed or unwashed blood transfusion?

The development of complex surgical procedures for the treatment of a number of diseases has increased the demand for allogeneic blood. In hospitals, up to 50% of transfused blood units are used in the surgical setting and up to 60% of all transfusions are given to patients over 65 years old, an age group of patients who are excluded from altruistic blood donation in some countries1,2. The demand for allogeneic blood often exceeds the supply. The safety of allogeneic blood transfusion (ABT) in developed countries has improved dramatically, especially as a result of more restrictive criteria for donor selection and increased analytical screening of donated blood which have led to a decrease in the rate of transfusion-transmitted infections. However, “clerical mistakes” or administration of “wrong blood” are still too frequent (1/15,000-20,000 units)3,4. Liberal transfusion protocols (pre-transfusion haemoglobin [Hb] concentration > 9-10 g/dL) should, therefore, be avoided to further reduce the risk of infection and other complications such as incompatible haemolytic reactions, Graft-versus-Host Disease, metabolic disorders, Transfusion-Related Acute Lung Injury, and transfusion related immuno-modulation3,4. As for immuno-modulation, the results of three extensive studies involving more than 22,000 patients undergoing orthopaedic surgery strongly suggest that peri-operative ABT is associated with an increase in the risk of post-operative infection5–7. Overall concerns about the adverse effects of ABT have prompted the review of transfusion practices and the search for transfusion alternatives, such as pre-operative autologous blood donation, haemodilution, peri-operative cell salvage, recombinant human erythropoietin (rHuEPO) and iron, or anti-fibrinolytic administration8. The ultimate objective is to minimise exposure to ABT and, therefore, ABT-associated risks. The main objective of this review is to provide updated evidence on the quality, safety and efficacy of postoperatively salvaged shed blood (PSB) after major surgery. However, the results of a systematic review indicate that reinfusion of unwashed filtered PSB after cardiac surgery produces only a marginal benefit9 and can also cause significant adverse effects, so its use is not recommended10. We, therefore, shall focus mainly on the use of PSB in orthopaedic surgery, especially lower limb joint replacement.

Bar code-based pre-transfusion check in pre-operative autologous blood donation

Background The objective of this study was to demonstrate the feasibility of a bar code-based identification system for the pre-transfusion check at the bedside in the setting of pre-operative autologous blood donation (PABD). Materials and methods Between July 2003 and December 2008 we determined the compliance rate and causes of failure of electronic bedside checking for PABD transfusion. Results A total of 5627 (9% of all transfusions) PABD units were administered without a single mistransfusion. The overall rate of compliance with electronic checking was 99%. Conclusions The bar code-based identification system was applicable to the pre-transfusion check for PABD transfusion.

A case‐control study of factors associated with resolution of hepatitis C viremia in former blood donors (CME)

Nucleic acid testing (NAT) is performed on blood collected in the United States allowing for the classification of hepatitis C virus (HCV) antibody-positive donors into resolved and chronic hepatitis C infections. We report a case-control study of factors associated with HCV resolution. Blood donors with resolved (HCV antibody positive, RNA negative defined as "cases") or chronic (HCV antibody positive, RNA positive defined as "controls") based on their index donation HCV test results were enrolled. Participants completed a risk factor, symptoms, and treatment questionnaire followed by HCV antibody, HCV RNA, and liver biochemical testing. We enrolled 100 cases and 202 controls. In a multivariate logistic regression model, significant independent effects for spontaneous viral clearance were observed for African American (inverse; odds ratio [OR], 0.11; 95% confidence interval [CI], 0.01-0.87), autologous blood donation (OR, 4.70; 95% CI, 2.02-10.94), alcohol intake (OR, 2.39; 95% CI, 1.13-5.03), and transfusion before May 1990 (inverse; OR, 0.36; 95% CI, 0.14-0.91). Cases admitting injection drug use had shorter time since first injection than did controls. Forty-nine index RNA positive controls received antiviral therapy and 25 (51%) were RNA negative at enrollment; surprisingly several RNA-negative cases received liver biopsies and/or antiviral treatment. We document the role donor screening plays in the identification, subsequent medical evaluation, and treatment among individuals who presumably did not know that they were at risk for HCV infection. Additionally, we confirmed race/ethnicity as a determinant of clearance and suggest infectious dose and route of infection may play a role in clearance.