Autologous Blood Donation Research Articles

Revisiting transfusion safety and alternatives to transfusion

Transfusion of blood products can be life saving when used appropriately. It carries however at the same time a potential for morbidity and mortality, depending on the patient, the product or the setting. Numerous strategies have been elaborated to minimize these risks, and in recent years, transfusion has no longer been regarded as essential for the management of a wide range of diseases. Uncomplicated surgeries in well-prepared patients can now be conducted without the use of transfusions. Questions about transfusion safety and shortage have led to extensive research on alternatives to blood transfusion, ranging from non-pharmacological to pharmacological solutions. Restrictive transfusion therapies, preoperative autologous blood donations, perioperative red cell salvage, acute normovolaemic haemodilution techniques or patient blood management are potential solutions where prothrombin complex or fibrinogen concentrates, synthetic anti-fibrinolytic agents, desmopressin, rFVIIa, or erythropoiesis stimulating agents may play a complementary pharmacologic role.

Gasless single-port laparoscopic-assisted vaginal hysterectomy for large uteri weighing 500 g or more

ObjectiveTo evaluate the safety and feasibility of gasless transumbilical single-port laparoscopic-assisted vaginal hysterectomy (LAVH) for the management of large uteri weighing 500g or more. Study designWe conducted a retrospective comparative study of women with large uteri, each undergoing gasless multi-port or single-port LAVH. Preoperatively, gonadotropin-releasing hormone agonist was administered and autologous blood was donated except for cases requiring immediate surgery. Additionally, intraoperative blood salvage and donation was performed in select cases. In single-port LAVH, a wound retractor was used to make a working port through umbilical incision. After the surgical view was secured using an abdominal wall-lift device, the surgical procedures were performed using conventional laparoscopic instruments. In select cases, temporary endovascular occlusion of the bilateral internal iliac arteries was performed to reduce intraoperative hemorrhaging. ResultsOf the 650 women managed by multi-port or single-port LAVH, 55 and 67 women each with uteri weighing 500g or more, respectively, were included. In single-port LAVH group, the median age was 47 years. Twelve women were nulliparous and 3 women with 2 cesarean deliveries each, had never had a vaginal delivery. The most frequent surgical indication was uterine myoma. In the single-port LAVH group, the surgical procedures included LAVH alone (n=36), LAVH and bilateral salpingo-oophorectomy (n=22), LAVH and unilateral salpingo-oophorectomy (n=8), and LAVH and appendectomy (n=1). Extensive adhesiolysis was required in eight cases. The median extirpated tissue weight was 652g with a median estimated intraoperative blood loss of 450mL. A significant positive linear correlation was observed between the operative time or estimated blood loss and the extirpated uterine weigh. Although excessive bleeding exceeding 1000mL was noted in 15 cases, a transfusion of bank blood was not required by using preoperatively donated autologous blood and intraoperative autologous blood salvage and donation. Extended hospitalization was required in six cases. The median surgical duration in the single-port LAVH group was significantly longer than that in the multi-port LAVH group. ConclusionGasless single-port LAVH is a feasible alternative that can yield similar major surgical outcomes as multi-port LAVH, with potential cosmetic benefit.

Role of Recombinant Human Erythropoietin and Parenteral Iron on Autologous Blood Donation in Neurosurgical Patients

Role of Recombinant Human Erythropoietin and Parenteral Iron on Autologous Blood Donation in Neurosurgical Patients

Indications and organisational methods for autologous blood transfusion procedures in Italy: results of a national survey.

Pre-operative donation of autologous blood is a practice that is now being abandoned. Alternative methods of transfusing autologous blood, other than predeposited blood, do however play a role in limiting the need for transfusion of allogeneic blood. This survey of autologous blood transfusion practices, promoted by the Italian Society of Transfusion Medicine and Immunohaematology more than 2 years after the publication of national recommendations on the subject, was intended to acquire information on the indications for predeposit in Italy and on some organisational aspects of the alternative techniques of autotransfusion. A structured questionnaire consisting of 22 questions on the indications and organisational methods of autologous blood transfusion was made available on a web platform from 15 January to 15 March, 2013. The 232 Transfusion Services in Italy were invited by e-mail to complete the online survey. Of the 232 transfusion structures contacted, 160 (69%) responded to the survey, with the response rate decreasing from the North towards the South and the Islands. The use of predeposit has decreased considerably in Italy and about 50% of the units collected are discarded because of lack of use. Alternative techniques (acute isovolaemic haemodilution and peri-operative blood salvage) are used at different frequencies across the country. The data collected in this survey can be considered representative of national practice; they show that the already very limited indications for predeposit autologous blood transfusion must be adhered to even more scrupulously, also to avoid the notable waste of resources due to unused units.Users of alternative autotransfusion techniques must be involved in order to gain a full picture of the degree of use of such techniques; multidisciplinary agreement on the indications for their use is essential in order for these indications to have an effective role in "patient blood management" programmes.

Research advances on perioperative blood management for total knee arthroplasty

Acute blood loss anemia is the most common surgical complication of total knee arthroplasty. Currently, allogeneic transfusion has been the major method of managing postoperative anemia. Although allogeneic transfusion can correct anaemic condition temporarily, it can lead to severe complications, such as postoperative infection, prolongation of physical recovery, increased length of hospital stay, and increased mortality. Perioperative blood management can effectively reduce blood loss and transfusion rate. These strategies mainly focus on three parts: therapy for anemia and autologous blood donation before operation; application of a tourniquet, antifibrinolytic drugs, topical hemostatic agents and acute normovolemic hemodilution during operation; selection of reinfusion systems, restrictive transfusion thresholds, drainage and knee position after operation. Perioperative blood management should run throughout the perioperative period, which mainly aims at reducing blood loss and blood transfusion, improving prognosis, promoting the postoperative recovery and lowering the medical cost. Depending on the actual situations of patients, surgeons should combine different major characteristics of each strategy and weigh the pros and cons to make effective and reasonable individualized treatment plan.

Elevated HbA1c Levels Are Associated with the Blunted Autonomic Response Assessed by Heart Rate Variability during Blood Volume Reduction.

A high glycemic status increases the risk for autonomic dysfunction and cardiovascular failure. The aim of this study was to investigate time-dependent changes in the autonomic response and cardiovascular dynamics and the association between the level of hemoglobin A1c (HbA1c) and autonomic response during blood volume reduction. The study population consisted of 26 preoperative participants who were scheduled for autologous blood donation (200-400 mL of whole blood) for intraoperative or postoperative use. These participants without circulatory, respiratory, or brain disease and diabetes mellitus were grouped according to their HbA1c levels: < 6.5% (n = 18) and ≥ 6.5% (n = 8). We measured blood pressure (BP) and analyzed heart rate variability (HRV) to quantify cardiac autonomic regulation throughout blood donation. During blood volume reduction, which was about 10% of the circulating blood volume, the BP and heart rate varied within normal ranges in both groups. The high-frequency (HF) component, an index of parasympathetic nerve activity, and the ratio of low-frequency (LF) to HF components (LF/HF), an index of sympathetic nerve activity, significantly decreased and increased with the progression of blood volume reduction, respectively, in the HbA1c < 6.5% group. In contrast, in the HbA1c ≥ 6.5% group, the HF component did not significantly change, and the increase in the LF/HF ratio was delayed. Time-dependent changes in HRV were related to blood volume reduction only in the HbA1c < 6.5% group. Thus, elevated HbA1c levels are associated with the decrease in the autonomic response induced by blood volume reduction.

Pre-Operative Autologous Blood Donation Does Not Affect Pre-Incision Hematocrit in Adolescent Idiopathic Scoliosis Patients. A Retrospective Cohort of a Prospective Randomized Trial.

Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been used in deformity surgery. The effect of pre-donation on pre-operative hematocrit (Hct) remains debated. Multiple factors may influence pre-operative Hct including intravascular volume status, patient factors, and timing of pre-operative blood donation. The purpose of this study was to determine if pre-donation significantly lowers pre-incision Hct in AIS patients. A retrospective cohort study of a Level-1 prospective randomized trial was conducted. 125 patients from the homogeneous population were included. AIS patients undergoing a posterior only spinal fusion for AIS were separated into two groups based on their pre-operative blood donation history. Demographic variables, pre-incision Hct, and transfusion rates were compared between the two groups using the Student's T-test. Pre-donation and non pre-donation groups had 28 and 97 patients, respectively. Pre-donation group was 75% female (21F, 7M) and non pre-donation group was 78% female (76F, 21M). There was no difference between pre-donation and non pre-donation groups in mean age (15.6 ± 2.2 vs 14.8 ± 2.2, p = 0.081), BMI (23.1 ± 4.2 vs 21.7 ± 5.3, p = 0.219), and pre-incision Hct (32.8 ± 3.4 vs 33.8 ± 3.1, p = 0.628). The overall transfusion rates were equivalent (32.1± 48.0% vs 25.8 ± 44.0%, p = 0.509), however, the rate of allogenic transfusion for the pre-donation group was significantly lower (3.6 ± 18.9% vs 25.8 ± 44.0%, p = 0.011). This study supports the use of pre-donation for AIS, without a significant drop in pre-incision Hct. Patients that donate are also much less likely to be exposed to allogenic blood. There may be a surgeon bias to recommend pre-donation in patients with a larger BMI and older age. Future studies are needed from a larger population of patients including those with non-AIS pathology. Level III.

A review of the application of autologous blood transfusion.

Autologous blood transfusion (ABT) has been gradually attracting more attention due to the increasingly prominent problem of blood transfusion safety and blood shortage in recent years. With the rapid development of blood conservation techniques, blood component separation technology, blood transfusion medicine and a constant increase in clinical needs, ABT technology has been expanded and innovated to a large degree. In this study, the development of preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH), intraoperative and postoperative autotransfusion, and other new technologies and theories are reviewed and existing questions are analyzed. Challenges and applications are also discussed in order to provide reference for peers.

Efficacy of Ferrous Bisglycinate Chelate for the Management of Preoperative Anaemia in Orthopaedic Surgical Patients: A Prospective Study

Background: Oral iron support in patients (pts) undergoing preoperative autologous blood donation (PABD) programs has been suggested by different authors to improve red blood cell (RBC) production and limit iron depletion. Oral iron therapy, however, is frequently associated with side effects and poor pts compliance. The aim of this study was to evaluate the effectiveness of low doses of ferrous bisglycinate chelate (Tecnofer, Baldacci) a new oral iron preparation characterized by high gastrointestinal absorption and tolerability in the management of preoperative anemia. Material and methods: In our hospital we used a multimodal approach of integrated alternatives strategies after a preliminary clinical evaluation (CE) that provides a supportive iron therapy. We enrolled 60 pts candidate for orthopedic surgery presenting hemoglobin (Hb) levels between 11.5 and 12.5 g/dL in order to evaluate the effectiveness of ferrous bisglycinate chelate for these pts who presented gastrointestinal side effects related to previous oral iron treatment. All pts pre-deposited 1 unit of PABD (400 mL) at day 0. Forty pts (Group A) received 1 tablet/day of ferrous bisglicinate (14 mg/day) for 10 days. No iron was given to 20 pts (Group B). The variation in Hb concentration, percentage of reticulocytes (% RET), serum ferritin (FER) and percentage of transferrin saturation (%SAT) from the day of pre-deposit to ten days after donation were compared between the two groups. Results: The study lasted From October 2014 to December 2014 baseline Hb, RET count, serum FER and transferrin saturation were similar in the 2 groups. Pts receiving iron therapy had a lesser iron depletion, an increased erythropoiesis which in turn limited Hb reduction due to PABD, without showing any side effects. Discussion: Preliminary data of our study seem to indicate that oral administration of low doses of ferrous bisglycinate chelate is an effective and safe therapy to support PABD and to treat iron deficiency in patient’s candidate for major surgery. The high patient’s compliance to this new oral iron therapy seems to be a “Key Factor” in the treatment success.

Balancing Thromboprophylaxis and Bleeding in Total Joint Arthroplasty: Impact of Eliminating Enoxaparin and Predonation and Implementing Pneumatic Compression and Tranexamic Acid

BackgroundVenous thromboembolic disease (VTED) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) poses substantial risk. Pharmacologic prophylaxis against VTED can cause bleeding, transfusion, and associated complications. The ActiveCare+SFT is a portable, intermittent pneumatic compression device (IPCD), providing equivalent VTED prophylaxis to pharmacologic agents without associated bleeding. Tranexamic acid (TXA) is an antifibrinolytic that reduces blood loss after THA and TKA. Our objective was to measure blood transfusion and VTED after eliminating enoxaparin, introducing an IPCD, eliminating autologous blood transfusion, and administering TXA during primary TKA and THA. MethodsFour consecutive cohorts of THA and TKA patients were studied. Group A, the historical control, received enoxaparin VTED prophylaxis. Group B received IPCD VTED prophylaxis. Group C received IPCD VTED prophylaxis along with TXA (1 g intravenous at incision and closure). Groups A, B, and C predonated 1 unit of autologous blood. Group D received IPCD VTED prophylaxis, TXA as above, but did not donate blood preoperatively. ResultsSeventeen of 50 patients (34%) in Group A, 7 of 47 (14.9%) patients in Group B, 4 of 43 (9.3%) patients in Group C, and 0 of 46 patients in Group D received transfusions. There were no major symptomatic VTED events. ConclusionUsing an IPCD and TXA and discontinuing enoxaparin and preoperative autologous blood donation eliminated blood transfusion in primary THA and TKA without any increase in VTED. Using an IPCD instead of enoxaparin, adding TXA, and eliminating preoperative autologous donation each had an incremental dose response effect. This protocol provides effective VTED prophylaxis equivalent to pharmacologic methods and eliminates transfusion risk in the primary THA and TKA population.

Effect of preoperative autologous blood donation on patients undergoing bimaxillary orthognathic surgery: a retrospective analysis

The efficacy of preoperative autologous blood donation (PABD) was evaluated according to preoperative haemoglobin (Hb) values. The records of 295 patients who underwent bimaxillary orthognathic surgery between July 2007 and August 2008 were reviewed. The records for autologous blood donation, intraoperative transfusion, and related laboratory studies were also evaluated. The transfusion trigger used during this period was Hb <10g/dl. A total of 189 patients (64.1%) made a PABD and 106 patients (35.9%) did not. The incidence of allogeneic blood transfusion was significantly lower in the PABD group than in the no PABD group (15.9% vs. 29.2%, P=0.007). This difference was greater in patients with a preoperative Hb <14g/dl (20.3% vs. 62.5%, P<0.0001), and no difference was found in patients with Hb ≥14g/dl (13.3% vs. 14.9%, P=0.83). PABD reduced the incidence of allogeneic blood transfusion in patients undergoing bimaxillary orthognathic surgery, particularly in patients with a preoperative Hb <14g/dl. PABD could be used to reduce the frequency of intraoperative allogeneic blood transfusion in these patients.

Preoperative Autologous Blood Collection for Bone Marrow Harvests: Is It Justified?

IntroductionPreoperative autologous donation prior to bone marrow harvest is commonly performed at our hospital. We usually collect 2 units of autologous blood from the bone marrow donors prior to the harvest procedure. In order to save an additional trip to the donor center, we sometimes collect double red cell by apheresis procedure. The decision for doing double red cell collection is based on the donor's hemoglobin and willingness to undergo the procedure. We reviewed all the autologous collections performed at our hospital based blood bank over a period of 2 ½ years. The utilization rate of autologous units, cost effectiveness and donor adverse events were evaluated.Methods:A computerized search was performed for all the autologous donations performed between January 2013 and July 2015. The charts of only the donors undergoing bone marrow harvest were reviewed. All other indications for preoperative autologous blood donation were excluded. The pre-donation hemoglobin (HB), time from donation to day of surgery, and any adverse events during autologous donation were recorded. The preoperative HB values (usually 1- 3 days before surgery) and the amount of marrow harvested were also noted. The utilization of the collected units was evaluated by reviewing all the units that were transfused and those that expired on shelf. The cost effectiveness of all the autologous collections was evaluated.Results:A total of 262 autologous units were collected from 137 donors in age range 9-72 years (M:F = 1.3:1). Double red cell collection by apheresis was performed on 49 of 137 (36 %) donors in one visit. The remaining 88 donors underwent autologous collection of 1 to 2 units of whole blood. Five donors donated more than 2 autologous units throughout this time period. Among the 49 double red cell donors, only 3 were females and remaining 46 were males. Among the whole blood donors, 56 were females and 32 were male. The mean baseline HB prior to autologous donations was 12.9 g/dL (range 11 to 15) in female donors and 15.2 (range 12.5 -17.8) in male donors. The average amount of marrow harvested was 1232 cc (range 480 - 2000 cc). The average fall in HB (measured as the difference between the baseline HB and the HB prior to surgery) was 2.07 (range 0 to 4.6). The HB loss resulting from the procedure was not available since most of the donors undergoing marrow harvest were transfused in the operating room at the end of the procedure. Out of the 102 units collected by double red cell apheresis, 39 units (38 %) expired on shelf. Among the 160 whole blood autologous units, 25 units (16 %) expired on shelf. The overall utilization rate of all the autologous units was 75.5%. The marrow harvest was either cancelled or rescheduled in 15 donors. Three donors received allogeneic blood post operatively in addition to the autologous unit. The pre harvest HB was 10 or above in 93% of the donors. All the donors tolerated the marrow harvest procedure well. No severe adverse events were noted during any of the autologous donations.Conclusion:The instituitional trigger for transfusing blood is 9.0 g/dL and 93% of our donors had a pre-operative HB above 10 g/dL. Hence we conclude that these healthy donors can easily undergo the marrow harvest procedure without requiring any transfusion. The pre-operative autologous donations are unnecessary, time and resource consuming, costly for the donor and can be detrimental to donor's health by potentially exposing them overall to any type of blood. DisclosuresNo relevant conflicts of interest to declare.

Efficacy of Erythropoietin-Beta Injections During Autologous Blood Donation Before Spinal Deformity Surgery in Children and Teenagers.

Retrospective observational study OBJECTIVE.: To clarify the efficacy of recombinant human erythropoietin-beta (EPO-beta) injections during autologous blood donation (ABD) before spinal deformity surgery in children and teenagers. ABD is preferred for spinal deformity surgery. A few studies have assessed the usefulness of preoperative ABD with EPO-beta in anemic patients. Fifty-six spinal deformity surgery patients (41 females, 15 males; median age: 15 yrs; range, 5-19 yrs) underwent preoperative ABD. ABD was performed weekly according to the patient's body weight with a subcutaneous EPO-beta injection (24,000 U). The collected blood volumes were compared among the low hemoglobin (low-Hb) (<13 g/dL), mid-Hb (13-13.9 g/dL), and high-Hb (≥14 g/dL) groups using the Kruskal-Wallis test. The effects of EPO-beta injection on the Hb levels were estimated using a linear mixed model. The patients underwent a median of four ABD collections (range, two to six). The median collected volume per ABD was 200 mL (range, 40-400 mL). The median total blood collection was 700 mL (range, 160-1,350 mL); the corresponding values were 700 mL, 700 mL, and 800 mL in the low-Hb, mid-Hb, and high-Hb groups, respectively (P = 0.964). The median blood loss was 500 mL (range, 10-2,940 mL); 53 out of 55 patients (96%) did not require unplanned allogeneic transfusion, including 11 out of 12 (92%) cases with blood loss >1,000 mL. The additional recovery of Hb levels with one EPO-beta injection was 0.29 ± 0.14 g/dL (P = 0.039) after adjusting for confounding factors. ABD with an EPO-beta injection is useful for avoiding allogeneic transfusion during spinal deformity surgery in children and teenagers, and patients in the low-Hb group achieved ABD volumes equivalent to those in the high-Hb group. Thus, an additional recovery of Hb levels of 0.29 g/dL per injection can be expected after 1 week. 4.

Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries: a propensity-matched cohort analysis.

The goal of this study was to examine the effectiveness of preoperative autologous blood donation (PABD) in adult spinal deformity (ASD) surgery. Patients undergoing single-stay ASD reconstructions were identified in a multicenter database. Patients were divided into groups according to PABD (either PABD or NoPABD). Propensity weighting was used to create matched cohorts of PABD and NoPABD patients. Allogeneic (ALLO) exposure, autologous (AUTO) wastage (unused AUTO), and complication rates were compared between groups. Four hundred twenty-eight patients were identified as meeting eligibility criteria. Sixty patients were treated with PABD, of whom 50 were matched to 50 patients who were not treated with PABD (NoPABD). Nearly one-third of patients in the PABD group (18/60, 30%) did not receive any autologous transfusion and donated blood was wasted. In 6 of these cases (6/60, 10%), patients received ALLO blood transfusions without AUTO. In 9 cases (9/60, 15%), patients received ALLO and AUTO blood transfusions. Overall rates of transfusion of any type were similar between groups (PABD 70% [42/60], NoPABD 75% [275/368], p = 0.438). Major and minor in-hospital complications were similar between groups (Major PABD 10% [6/60], NoPABD 12% [43/368], p = 0.537; Minor PABD 30% [18/60], NoPABD 24% [87/368], p = 0.499). When controlling for potential confounders, PABD patients were more likely to receive some transfusion (OR 15.1, 95% CI 2.1-106.7). No relationship between PABD and ALLO blood exposure was observed, however, refuting the concept that PABD is protective against ALLO blood exposure. In the matched cohorts, PABD patients were more likely to sustain a major perioperative cardiac complication (PABD 8/50 [16%], NoPABD 1/50 [2%], p = 0.046). No differences in rates of infection or wound-healing complications were observed between cohorts. Preoperative autologous blood donation was associated with a higher probability of perioperative transfusions of any type in patients with ASD. No protective effect of PABD against ALLO blood exposure was observed, and no risk of perioperative infectious complications was observed in patients exposed to ALLO blood only. The benefit of PABD in patients with ASD remains undefined.

Predictive factors for perioperative blood transfusion in neck dissection.

There is growing interest in reducing the exposure of patients to allogeneic blood transfusions by lowering preoperative cross-matched blood ordering and adopting alternative practices, such as autologous blood donations. Our aim was to investigate the predictors for perioperative blood transfusion (PBT) in head and neck cancer patients undergoing neck dissection (ND). Retrospective cohort study. Retrospective observational study. All patients who underwent ND between January 2011 and August 2014. The primary outcome measure was PBT. Predictors tested included: gender, age, American Society of Anesthesiologists comorbidity score, Charlson comorbidity index, preoperative hemoglobin level, head and neck primary tumor location, tumor and nodal staging, side and laterality of ND, central versus lateral ND, elective ND, preoperative chemotherapy/radiotherapy/I(131) therapy, history of previous ND, other surgical procedures in addition to the ND, bone resection, use and type of reconstruction, and the use of bony free flap reconstruction. Twenty-one preoperative and operative variables were tested for an association with PBT using univariate and multivariate analyses. Multivariate analysis found only the following three predictors to be significantly associated with PBT in patients undergoing ND: low preoperative hemoglobin level, advanced N stage, and concurrent reconstructive surgery. Evaluation of specific risk factors for predicting the need for PBT prior to neck dissection may be helpful in identifying the head and neck cancer patients in whom preoperative ordering of cross-matched blood is required or who could benefit from alternative means, such as preoperative autologous blood donation. 4.

Alterations in HbA1c resulting from the donation of autologous blood for elective surgery in patients with diabetes mellitus.

The aim of this study was to confirm the change in haemoglobin A1c consequent to pre-operative donation of autologous blood for elective surgery in patients with diabetes mellitus. For enrolment in this prospective study, patients had to be scheduled for multiple autologous blood donations at different times and have a haemoglobin A1c level more than 5.8% at the first donation. The values of four factors, haemoglobin, haemoglobin A1c, glycated albumin, and glycated albumin/haemoglobin A1c ratio were determined. Changes in the values of these four factors between before and after the blood donations were calculated. In all 24 patients studied, haemoglobin and haemoglobin A1c decreased as a result of the autologous blood donations. The group with a reduced glycated albumin/haemoglobin A1c ratio had short intervals between blood donations. Correlations were observed between donation interval and change in haemoglobin A1c (r=-0.63, P=0.003), and between donation interval and change in the glycated albumin/haemoglobin A1c ratio (r=0.489, P=0.045). Haemoglobin A1c levels are likely to be underestimated after autologous blood donation by patients with diabetes mellitus, so glycated albumin may be a better indicator of these patients' glycaemic control.

Anaesthetic and pharmacological techniques to decrease blood loss in liver surgery: a systematic review.

There is increasing evidence that perioperative blood loss and blood transfusions are associated with poorer short- and long-term outcomes in patients undergoing hepatectomy. The aim of this study was to systematically review the literature for non-surgical measures to decrease intraoperative blood loss during liver surgery. The literature search was performed using PubMed, Embase, Cochrane Library, CINAHL and Google Scholar databases. The primary outcome measures were perioperative blood loss and transfusion requirements. A secondary outcome measure was development of ischaemia-reperfusion injury. Seventeen studies met the inclusion criteria and included 1573 patients. All were randomized controlled studies. In eight studies (n = 894), pharmacological methods, and in another nine studies (n = 679), anaesthetic methods to decrease blood loss were investigated. Anti-fibrinolytic drugs, acute normovolaemic haemodilution, autologous blood donation and use of inhalational anaesthetic agent may affect blood loss and post-operative hepatic function. There is potential for use of non-surgical techniques to decrease perioperative bleeding. However, on the basis of this review alone, due to heterogeneity of randomized trials conducted, no particular strategy can be recommended. Future studies should be conducted looking at pathways to decrease bleeding in liver surgery.

Preoperative Autologous Blood Donation: Waning Indications in an Era of Improved Blood Safety.

A downward trend in preoperative autologous donation (PAD) continues in Europe and the Americas, with many jurisdictions only funding medically necessary collections at present. This is the result of decreasing real and perceived residual risks of allogeneic transfusion-transmitted disease and the declining need for transfusion due to patient blood management, which have also led to escalating logistical and cost constraints for PAD programs. We outline collection trends in North America, Europe, and Latin America and review the benefits, risks, effectiveness, and safety of PAD. Important elements of informed consent follow from these points. Evidence-based medical criteria for PAD and autologous transfusion are discussed as are methods to optimize autologous collection timing to regenerate donated red cells. Recommendations for identification of patients whose risk-to-benefit ratio suggests substantial benefit compared with other autologous blood salvage and anemia management alternatives conclude the review.

Pertinence du prélèvement sanguin autologue et de sa transfusion lors d’un don de moelle osseuse

We assessed the benefit of predeposite autologous blood donation (PAD) before bone marrow (BM) donation on transfusion requirements, haemoglobin concentrations (Hb) and the occurrence of adverse events (AE). We collected data retrospectively from 50 donors of BM with PAD from 2010 to 2014. An autologous transfusion (AT) was given to 50% of the donors (group 1). In the group 2, the products from PAD were not used. The total volume median of marrow harvested was 17.7mL/k (range 12.3–21.4) in the group 1 and 13.3mL/k (8.6–22.6) in the group 2. The female ratio was higher in the group 1 (60%) than in the group 2 (16%). Bone marrow harvest led to a decline in Hb (from PAD to first day after BM donation) by 2.9g/dL (1.5–5.5) in the group 1 and by 3.5g/dL (1.2–5) in the group 2. The post-harvest Hb (D+1) median was identical in the two groups: 10.9g/dL (7.6–13.5) in the group 1 versus 11.5g/dL (9.3–13.4) in the group 2. Six AE were reported in each group. In the group with AE, the median weight was lower: 58 k (50–71) versus 75 k (52–110); and the median total volume of marrow harvested was higher: 20.1mL/k (9.9–21.4) versus 14.3mL/k (8.6–22.6). All post-harvest Hb were ≥ 7.6g/dL. This study shows the high loss of Hb after BM donation but not enough to prove a blood transfusion in BM donors with median age of 36 years (16–62) and without comorbidity. The occurrence of AE (25% of BM donors) justifies a careful surveillance after the BM donation. The PAD should not be routinely offered to bone marrow donors.

Management of operative blood loss in spinal deformity surgery

Background: Surgery for spinal deformity is associated with high levels of blood loss that may be increased with certain patient factors and complex or revision procedures that include osteotomies. Major blood loss is a vital consideration in patients undergoing complex spine surgery not only because of direct hemodynamic consequences but also because of the potential complications associated with allogeneic blood administration. The purpose of this review is to describe the current evidence supporting blood conservation techniques in spinal deformity surgery. Methods: A MEDLINE search for all articles concerning blood conservation techniques in spine surgery was undertaken. The literature search was limited to articles in English. Results: Major blood conservation techniques in spinal deformity surgery after thorough review of patient factors (i.e. patient age, sex, surgical indication, use of anticoagulant medications, baseline hematologic laboratory values, etc.), include preoperative autologous blood donation, erythropoietin supplementation, controlled intraoperative hypotension, anesthesia, perioperative autologous cell salvage, use of antifibrinolytics, acute normovolemic hemodilution, and postoperative blood salvage. Conclusions: A number of preoperative, intraoperative, and postoperative considerations for blood salvage exist. Techniques such as the use of antifibrinolytics, controlled hypotension, and perioperative autologous cell salvage are strong options to decrease the blood loss burden for each patient. Other techniques, such as preoperative autologous blood donation, have limited supporting data and should be used only in specific patients. A thorough consideration of these techniques can lead to lower surgical morbidity and better patient outcomes.