Efficacy Of Preoperative Autologous Blood Donation Research Articles

Predeposit autologous donation in spinal surgery: a multicentre study.

Allogeneic blood transfusions (ABT) are often necessary in elective spine surgery because of perioperative blood loss. Preoperative autologous blood donation (PABD) has emerged as the principal means to avoid or reduce the need for ABT. Consequently, a multicentre study was conducted to determine the yield and efficacy of PABD in spine surgery and the possible role of recombinant human erythropoietin (EPO) in facilitating PABD. We retrospectively reviewed the hospital charts and blood bank records from all consecutive spine surgery patients who were referred for PABD. Data were obtained from two A-category hospital blood banks and one general hospital. Although we collected data from 1994, the analytic study period was from the last quarter of 1995 to December 2003. Fifty-four (7%) out of 763 patients referred for PABD were rejected, and medical records were available for 680 patients who were grouped into spinal fusion (556; 82%) and scoliosis surgery (124;18%). EPO was administered to 120 patients (17.6%). From 1999 to 2003, PABD steadily increased from 60 to 209 patients per year. Overall, 92% of the patients were able to complete PABD, 71% were transfused, and almost 80% avoided ABT. PABD was more effective in fusions (86%) than in scoliosis (47%). Blood wastage was 38%, ranging from 18% for scoliosis to 42% for fusions. EPO allowed the results in the anaemic patients to be improved. Therefore, despite the limitations of this retrospective study, we feel that PABD is an excellent alternative to ABT in spine surgery. However, the effectiveness of PABD may be enhanced if associated with other blood-saving techniques.

Efficacy of preoperative autologous blood donation: analysis of blood loss and transfusion practice in total hip replacement

Study Objective: To determine the frequency of allogeneic transfusion for total hip replacement (THR) surgery and to examine the efficacy of preoperative autologous blood donation (PABD) under specified, standardized blood transfusion guidelines. Design: Prospective, nonrandomized study. Setting: University medical center. Patients: All ASA physical status I, II, III, and IV patients undergoing single, primary, THR surgery from April 1998 to March 1999. Interventions: All patients received standardized transfusion and anticoagulation therapy. Demographic, blood loss, and transfusion data were collected and compared between all patients participating in PABD (donors) and patients not participating in PABD (nondonors). Overall allogeneic blood exposure was established. Since most anemic patients could not participate in PABD, allogeneic transfusion frequency was also examined in a subset of nonanemic patients (hemoglobin ≥ 12 g/dL) who were potentially able to participate in PABD. Measurements and Main Results: n = 231 patients, 142 donors and 89 nondonors. Mean estimated blood volume (EBV) of donors was 4991 ± 1042 mL versus nondonors 4631 ± 1108 mL (p < 0.01). ASA physical status I–II/III–IV among donors was 118/24 versus nondonors 61/28 (p < 0.01). Overall allogeneic blood exposure was 22% (51/231). Allogeneic transfusion frequency for all donors was 15% (22/142) versus nondonors 33% (29/89) (p < 0.05). Among nonanemic patients, donor versus nondonor EBV and ASA physical status I–II/III–IV were 5074 ± 1019 mL versus 4743 ± 1172 mL and 107/20 versus 48/15 (p = NS); allogeneic transfusion frequency reduced to 13% (16/127) versus 17% (11/63) (p = NS), respectively. Conclusions: Allogeneic blood exposure was >10% despite the use of PABD. The efficacy of PABD has been obscured by the fact that donors of autologous blood tend to be larger and healthier than nondonors. After exclusion of anemic patients, autologous donors and nondonors were clinically comparable and the difference in allogeneic blood exposure was not statistically significant. PABD offers only a modest, if any, benefit for THR surgery.

Cost-effectiveness of Autologous Blood Predonation

SUMMARY The diminishing risks of allogeneic transfusion and the recognition of limited health care budgets cast doubt on the value of preoperative autologous blood donation (PABD). The criteria for estimating the alleged benefit of PABD are provided by the discipline of clinical epidemiology and are referred to as efficacy, effectiveness and efficiency. The efficacy of PABD can be assumed for colorectal cancer surgery, hip replacement and liver resection. PABD may be efficacious in most other elective surgical interventions with significant, anticipated blood loss. PABD is effective in these cases if there is no significant risk of donation or if a high statistical or individual risk of allogeneic transfusion isto be prevented. PABD is probably efficient, i.e. cost-effective, if additional conditions such as low patient age, low production cost and/or high transfusion probability additionally apply. Production costs can be reduced by storing and delivering autologous blood as whole blood without harm to the patient.