Homologous Blood Requirements Research Articles

Clinical Experience of Autologous Blood Transfusion in Neurosurgery: Prospective Study in Central India

To evaluate the benefits of intraoperative autologous blood transfusion in intracranial procedures and to conserve precious homologous blood due to shortage of donor and associated complications. This was a prospective study performed at Bansal Hospital, Bhopal. Predetermined autologous blood was collected in a well-labeled bag containing citrate phosphate dextrose adenine solution after induction of general anesthesia. Then appropriate amount of crystalloid solution was transfused in to the body. All collected autologous blood was transfused back to the patient at the end of the surgery or during the surgery if excessive blood loss occurred. Demographic data, hemodynamic changes (mean arterial pressure, heart rate) before and after donation, complications, and any additional homologous blood requirement were noted. Pre- and postoperative hemoglobin and hematocrit values were compared. In total, 32 patients were included in this study. In our study, mean age was 48.87 years; male-to-female ratio was 1:1.4. The mean amount of autologous blood collected was 461 mL, and the mean amount of blood loss during surgery was 1048 mL. In our study, there was no statistically significant difference was found in mean arterial pressure and heart rate before and after autologous blood collection (P > 0.05). When we compared pre- and postoperative mean hemoglobin and hematocrit levels, there was a statistically significant difference present (P<0.05); this was due to the fact that many patients had meningiomas (15 of 32). Additional homologous blood was required only in 25% of cases (8/32). Of 8 patients, 5 were again cases of deep-seated meningiomas. No complications were observed during or after autologous blood collection. Autologous blood transfusion is a safe, effective, and affordable method of blood transfusion in patients undergoing intracranial surgery. Complications associated with homologous blood transfusion can be avoided with autologous blood transfusion.

Cardiopulmonary bypass strategy with low-dose heparin and nafamostat mesilate in cardiac surgery: A safe option for patients with acute stroke

From the Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India; and theDepartment ofCardiology, St. John’sMedicalCollegeHospital,Bangalore, India. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Dec 13, 2011; revisions received March 2, 2012; accepted for publication March 16, 2012; available ahead of print April 27, 2012. Address for reprints: Naoto Morimoto, MD, PhD, Department of Cardiovascular Surgery, Himeji Cardiovascular Center, 520, Saishoko, Himeji, Hyogo, 670-0981, Japan (E-mail: naotofrcs@gmail.com). J Thorac Cardiovasc Surg 2012;144:726-8 0022-5223/$36.00 Copyright 2012 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2012.03.030

Post-operative blood salvage with autologous retransfusion in primary total hip replacement

Clinical, haematological or economic benefits of post-operative blood salvage with autologous blood re-transfusion have yet to be clearly demonstrated for primary total hip replacement. We performed a prospective randomised study to analyse differences in postoperative haemoglobin levels and homologous blood requirements in two groups of patients undergoing primary total hip replacement. A series of 158 patients was studied. In one group two vacuum drains were used and in the other the ABTrans autologous retransfusion system. A total of 58 patients (76%) in the re-transfusion group received autologous blood. There was no significant difference in the mean post-operative haemoglobin levels in the two groups. There were, however, significantly fewer patients with post-operative haemoglobin values less than 9.0 g/dl and significantly fewer patients who required transfusion of homologous blood in the re-transfusion group. There was also a small overall cost saving in this group.

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

The purpose of our study was to determine the effectiveness of a postoperative autologous blood reinfusion system as an alternative to homologous, banked blood transfusions in total knee arthroplasty. We carried out a prospective randomised controlled study on 60 patients having unilateral total knee replacements. In all these patients, the same surgical team applied the same surgical technique, and all patients followed the same rehabilitation program. In 30 of these patients (group A), a reinfusion system of unwashed salvaged blood was applied, and they were supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received one unit of homologous banked blood transfusion intraoperatively and additional blood transfusions postoperatively when required. The administration of banked blood transfusion was determined by the haemoglobin value (<9 mg/dl) and/or clinical signs (blood pressure, pulse, etc.). The values of haemoglobin, haematocrit and platelets were recorded preoperatively and the first, fifth and 15th postoperative days, respectively. Five patients of group A required nine units of homologous blood (0.3 units/patient) postoperatively. Ten patients of group B required an additional 15 banked blood units postoperatively (in total 45 banked blood units for group B; 1.5 units/patient). In the study group, the total homologous blood requirements were reduced by 80%, while the postoperative blood requirements were reduced by 50%. There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups. The cost of the blood management in the study group was reduced by 36%. The use of an autologous blood reinfusion system reduces highly effectively the demands of homologous banked blood transfusion in total knee arthroplasty.

Acute haemodilution in surgery for burns: a preliminary report.

Blood loss is a major problem in the management of patients with burns treated by early excision and grafting. Acute normovolaemic haemodilution has been successfully used in cardiac surgery for many years but has not been reported previously in surgery for burns. The technique has been used in six patients with burns undergoing early excision and grafting, with no obvious morbidity and an apparent reduction in homologous blood requirements.

Efficacy of Aprotinin in Reducing Blood Loss in Paediatric Patients Undergoing Major Spinal Surgery.

Blood loss during corrective surgery for scoliosis and the requirement for homologous blood is an important issue in paediatric spinal surgery. This is particularly pertinent in cases of scoliosis secondary to underlying neuromuscular disease where anaemia may be less well tolerated, both intra-operatively and post-operatively, due to multiple organ dysfunction. Despite the introduction of techniques to minimise the necessity to transfuse homologous blood (pre-deposit autologous donation, cell salvage and isovolaemic haemodilution), it is often required. This brings with it the potential risks of allo-immunization and infective complications. In the UK homologous blood is an increasingly precious resource following the recent exclusion of donors who have themselves received blood products in the last ten years in view of the potential risk of new variant CJD.Aprotinin, a serine proteinase inhibitor (now produced by recombinant technology) with antifibrinolytic properties and the ability to preserve platelet function has been shown to reduce blood loss in major cardiac surgery and liver transplantation. Its effectiveness in the orthopaedic setting has generated more varied reports, however in the setting of spinal surgery for idiopathic scoliosis it has recently been shown to reduce intra-operative blood loss and the requirement for homologous transfusion.We report here our experience with the use of aprotinin in a group of paediatric patients undergoing surgery for scoliosis secondary to an underlying neuromuscular disorder and its effect on intra-operative blood loss. 33 successive patients referred to our institution were allocated to receive aprotinin (n=18) or not (n=15). For those who received the drug a test dose of 50,000KIU was followed by a loading dose of 10,000KIU/kg over 30 minutes. A maintenance infusion was set up at 5,000KIU/hour for the duration of the procedure.The demographics of the two groups were not significantly different. The median age of those children receiving aprotinin was 12 years (7–15) and those who did not 13 years (7–17), [p=0.09]. The median weight of the children receiving aprotinin was 40kg (25–55) and those who did not 38.5kg (21–55), [p=0.74]. The procedures undertaken were posterior spinal fusion (n=26), anterior and posterior fusion (n=3), insertion of growing rods (n=2) and correction of kyphoscoliosis (n=2). All procedures were performed by one of three consultants. The operative time in the two groups was not significantly different, 6.5 hours (4.1–8.9) in those who received aprotinin and 5.7 (4.4–7) in those who did not [p=0.54].There was however a significant reduction in blood loss in the group who received aprotinin, with an average reduction of 51.6%. Median losses for those who received aprotinin were 1380ml (380ml–2380ml) and 2849ml (1047ml–4651ml) for those who did not [p=0.01]. No adverse events in the form of allergic reactions were observed in the children who received the drug. We conclude that aptotinin is a safe and effective pharmacological intervention which can be used in spinal surgery to reduce operative blood loss. This should translate into a reduced requirement for homologous blood although this was not determined in this study. Evaluation of this secondary endpoint is ongoing.

The effect of preoperative antiplatelet therapy in coronary artery surgery: blood transfusion requirements for patients on cardiopulmonary bypass

SUMMARYIntroduction: Bleeding after heart operations remains a common complication and contributes to morbidity and death. Recent studies have suggested that antiplatelet therapy (APT) may not increase homologous blood requirements in coronary bypass surgery. The purpose of this study was to examine the influence of APT therapy on haemorrhage and transfusion requirements in patients undergoing coronary artery bypass (CABG) on cardiopulmonary bypass (CPB).Materials and methods: Records from 290 consecutive patients who underwent CABG with CPB were retrospectively reviewed, including 145 patients who received APT within 5 days prior to surgery and 145 control patients (CON). Blood loss was measured up to 24 h. Demographic and clinical patient data were collected until hospital discharge.Results: Both groups were well matched with respect to demographic and intra-operative data.There was significantly ( p < 0.0005) more mediastinal tube drainage at 24 h in the APT group (1123 mL ± 537 mL) compared to CON patients (874 mL ± 351 mL). In addition, the APT group received significantly more units of blood (APT: 2.6 ± 2.5 vs CON: 1.6 ± 1.8; p < 0.0005), platelet units (APT: 1.2 ± 1.8 vs CON: 0.2 ± 0.8; p < 0.0005), and fresh frozen plasma units (APT: 2.0 ± 2.2 vs CON: 1.3 ± 2.0; p = 0.01).Conclusion: This study suggests consideration should be given to delaying elective CABG for patients who have received APT treatment until APT is discontinued for at least 5 days.

Comparing the usage of autologous blood transfusion with homologous blood transfusion in spine surgery

Autologous Blood Transfusion (ABT) is the safest type of blood transfusion for the operator and the patient. The preoperative donation technique had already been reduced the homologous blood requirements successfully. Homologous Blood Transfusion (HBT) brings more risks in complications such as transmission of diseases, anaphylactic reactions, haemolitic reactions etc. This was a parallel study, comparing one group receiving ABT and a second group receiving HBT where in both groups were performed spine surgery. The parameter used was the hemoglobin(Hb) and hematocrit(Ht) content preoperatively (after donation of ABT) and after transfusion, total days in hospitalization after surgery. Another purpose of this study was also to achieve understandings in using ABT by considering the total patients who finally required additional HBT. There were 74 patients with diagnosis of spine fracture, tuberculous spondylitis, scoliosis, spinal stenosis and spondylolisthesis. In the ABT group the average age was 33,9 ± 14 years old and the HBT group was 29,1 ± 11,5 years old. Both groups consisted of 21 males and 16 females. Body weight of the ABT group was 55,3 ± 11,1 kg and the HBT group 52,8 ± 9,7 kg. Amount of donations preoperatively in ABT was 798,6 ± 170 cc. There were 12 patients (32,4%) where the donated blood amount preoperatively did not match up the requests. There were eight patients (21,6%) in the ABT group that required additional HBT of about 550 cc. Three patients (8,1%) of the ABT group received transfusion that did not match the indications (blood loss &lt; 15% of the total blood volume). The Hb and Ht content preoperatively (after donation) of the ABT group significantly was less than the HBT group (p= 0,001). Hb content after transfusion in the ABT group was not significantly less than the HBT group (p = 0,30). Hospitalization days after surgery were significantly higher in the HBT group (p = 0,000). In conclusions : there was 21,6% of the ABT group with the preoperative donation technique that finally required additional HBT. Also there was no difference in the Hb and Ht content preoperatively and post transfusion in the ABT and HBT group, whereas hospitalization days after surgery were higher in the group receiving HBT than in the group receiving ABT. (Med J Indones 2004; 13: 17-23) Keywords: autologous blood transfusion, homologous blood transfusion, spine surgery

Autologous blood donation before elective off-pump coronary artery bypass grafting.

Preoperative autologous blood donation reduces exposure to homologous blood transfusions in cardiac surgery. The purpose of this study was to ascertain the volume of predonated autologous blood needed to avoid homologous blood transfusion in scheduled off-pump coronary artery bypass grafting (off-pump CABG). Fifty-six patients underwent scheduled off-pump CABG between January 1999 and December 2000. These patients all donated either 400 ml (group 1, n = 33) or 800 ml (group 2, n = 23) of autologous blood before operation. These patients donated at a rate of 400 ml per week. All patients were given an equal volume of saline solution at the time of autologous donation. There were no significant differences in the mean age, mean body weight, mean preoperative hematocrit values, mean graft number, or mean volume of intraoperative blood loss between groups 1 and 2. There was a significant difference in the mean postoperative day-7 hematocrit value (33.6% +/- 1.3% vs 39.3% +/- 1.3%, P << 0.05). The rates of avoiding homologous blood transfusion were 63.6% in group 1 and 100% in group 2 ( P << 0.05). Autologous blood transfusion is effective for reducing the homologous blood requirement. We believe that an 800-ml predonation is sufficient to avoid homologous blood transfusion in scheduled off-pump CABG; furthermore, patients with cardiovascular disease, including severe coronary artery disease, should be administered saline along with the blood donation.

Erythropoietin therapy and acute preoperative normovolaemic haemodilution in infants undergoing craniosynostosis surgery.

A retrospective study was performed to evaluate whether pretreatment with erythropoietin and iron combined with acute preoperative normovolaemic haemodilution (APNH) could decrease homologous blood transfusion in craniosynostosis (CS) surgery. A treated group was compared with a historical group of infants who underwent surgery with no pretreatment. The charts of 25 healthy infants who underwent CS surgery were reviewed. Nine of them underwent surgery with no treatment beforehand. Sixteen infants were given erythropoietin at a dosage of 300 U.kg -1 two times per week and iron (elemental iron 10 mg.kg-1.day-1) for 3 weeks before surgery. On the day of surgery APNH was performed after induction of general anaesthesia; a precalculated amount of autologous blood was withdrawn and replaced by hydroxyethyl starch 6%. Eleven of the 16 infants of the study group received only autologous blood. Five of 16 received homologous blood transfusion vs seven of nine infants in the control group. APNH combined with erythropoietin was effective in reducing homologous blood requirements during CS surgery. Further studies are necessary on a larger scale to assess the role of this technique in avoiding homologous blood transfusion and to evaluate how infants can benefit from this combined approach.

Post-operative red cell salvage in total knee replacement

Post-operative cell salvage (PCS) reduces homologous blood use after knee replacement but liberal indication for transfusion in previous studies resulted in high homologous transfusion requirements. We evaluated PCS in patients undergoing knee replacement using a restrictive transfusion trigger (Hb <8.5 g/dl). Forty patients underwent knee replacement with either PCS ( n=20) or with standard wound drains ( n=20). Blood losses and transfusion requirements were recorded prospectively. Mean (SD) post-operative blood loss with PCS was 656 (317) ml, of which 433 (197) ml were re-infused. Control blood loss was comparable at 591 (328) ml. Blood transfusion was given to only one PCS patient; 2 U, and five controls who received a total of 12 U of homologous blood. Homologous transfusion was not necessary for most patients undergoing knee replacement when the indication for transfusion was restricted. PCS further decreased homologous blood requirements.

Vascular surgical society of great britain and ireland: autologous transfusion reduces blood transfusion requirements in aortic surgery

BACKGROUND: Elective aortic surgery is associated with a blood loss that warrants a routine blood crossmatch of 4-6 units. Autologous transfusion strategies to reduce blood requirements were evaluated in a pilot study involving six hospitals in the North West. METHODS: Eighty patients undergoing elective aortic surgery were randomized to either autologous (a combination of acute normovolaemic haemodilution and intraoperative cell salvage) or homologous transfusion. The transfusion trigger, in the absence of pressing clinical need, was 8 g dl-1 haemoglobin for both groups. RESULTS: Randomization achieved two groups well matched for age, aneurysm or occlusive surgery, aspirin intake, estimated blood volume, preoperative haemoglobin and aneurysm size. In the 'best' hospitals (n = 49) mean(s.d.) blood loss (630(49) ml) was significantly lower (P < 0.01) than that in the 'worst' hospitals (1077(110) ml, n = 31) and fewer patients required transfusion (nine of 42 versus 15 of 30; P < 0.05). No significant differences were found between homologous and autologous groups for all variables measured in the 'best' hospitals. In the 'worst' hospitals blood requirements were significantly higher (P < 0.05) for the homologous group (800(112) ml) compared with the autologous group (489(65) ml), although blood loss was similar (1239(195) versus 915(92) ml respectively). CONCLUSION: Autologous transfusion techniques significantly reduced homologous blood requirements in aortic surgery where blood loss exceeded 800 ml.

Autologous or homologous transfusion in aortic surgery: randomized trial

Abstract Background Aortic surgery often requires blood transfusion, which may cause complications and postoperative infection. Autologous transfusion was evaluated in a multicentre clinical trial. Methods Some 145 patients undergoing elective aortic surgery in eight hospitals were randomized to either ‘homologous’ or ‘autologous’ transfusion, a combination of acute normovolaemic haemodilution (ANH) and intraoperative cell salvage. Homologous blood was administered when the haemoglobin concentration fell below 8 g dl−1. Results Median (interquartile range (i.q.r.)) blood loss was 668 (400–862) ml or 17 (10–24) per cent of blood volume in aortobifemoral bypass, and 1120 (765–1700) ml or 24 (17–36) per cent in aneurysm repair (P &amp;lt; 0·001). Autologous transfusion reduced homologous blood requirements from a median (i.q.r.) of 2 (0–4) units to 0 (0–2) units (P = 0·008). Independent predictors of blood transfusion were homologous transfusion strategy (odds ratio (OR) 2·3 (95 per cent confidence interval 1·1–5·0); P = 0·03), low preoperative haemoglobin concentration (OR 3·7 (1·7–8·2); P &amp;lt; 0·001), prolonged surgery (OR 2·1 (1·0–4·8); P = 0·05) and blood loss (OR 3·0 (1·4–6·5); P = 0·007). Patients with a preoperative haemoglobin concentration greater than 13·5 g dl−1 and who lost less than 20 per cent of their blood volume rarely required transfusion. There was no significant difference between the groups in terms of morbidity, mortality and postoperative hospital stay. Conclusion Autologous transfusion reduced the need for homologous blood in aortic surgery, but was useful only in patients with low haemoglobin levels or when blood loss exceeded 20 per cent of the blood volume. ANH alone is indicated for patients undergoing aortobifemoral bypass and in those with a higher haemoglobin level and blood volume.

Anaesthetic management and outcome in right-lobe living liver-donor surgery.

We reviewed retrospectively the anaesthetic management and perioperative course of eight right hepatectomies for living liver donation. After preoperative psychiatric evaluation, eight ASA I-II individuals donated the right lobe of their liver to a family member. A graft-recipient body weight ratio of 0.8-1.0% was required for patient selection. Indications for liver transplantation were: hepatitis C viral-related cirrhosis in six patients; combined hepatitis C and B viral cirrhosis in one patient; multifocal hepatocellular carcinoma--four lesions, involving both liver lobes--of hepatitis C viral-related cirrhosis in another patient. Indication for adult-to-adult living-donor liver transplantation was retained in the latter because of rapid deterioration of liver disease, rare recipient's blood group and extended, unresectable hepatocellular carcinoma. Hepatitis C viral-related cirrhosis was casually the primary indication for adult-to-adult living-donor liver transplantation in this group. The condition of the donated hepatic lobe was optimized by appropriate drug and perfusion management. Preoperative investigations included: blood tests (full cell count and film, thyroid function tests, pregnancy tests, full virological tests and bacteriological cultures, and immunological typing), chest radiograph, electrocardiogram plus Doppler cardiac ultrasound, spirometry, aminopyrine breath test, liver Doppler examination, magnetic resonance imaging, angiography and cholangiography and a volumetric study of the whole liver and the right lobe. Haemoglobin and lactate concentrations, liver function tests and international normalized ratio were measured before and after operation. The volume and weight of the resected right lobe was calculated. Anaesthesia was induced with propofol 300 mL h(-1) and sufentanil 0.3 microg kg(-1) intravenously; cisatracurium, 0.15 mg kg(-1), was given to facilitate tracheal intubation. Anaesthesia was maintained during normocapnic ventilation of the lungs with oxygen 40% in air, isoflurane 1-1.5 MAC and sufentanil. Routine anaesthetic monitoring included electrocardiography, pulse oximetry, invasive blood pressure, central venous pressure, urine output, state of neuromuscular blockade and core temperature. Periods of hypotension (<80% of the preoperative blood pressure) or haemodynamic instability (requiring inotropic or vasoactive support) were registered. Total blood loss and transfusion (homologous, autologous or cell-saver blood) requirements were measured; volume replacements were derived. Data are presented as mean (range). There was no morbidity or mortality and no periods of intraoperative hypotension or haemodynamic instability. The operation time averaged 619 (525-780)min. Four donors were extubated in the operating room immediately after surgery; the others were extubated in the intensive care unit, where the mean extubation time was 16.3 (5-25)h after arrival. The estimated blood loss was 967 (550-1,600)mL. No homologous blood was administered; five donors received autologous blood, intraoperatively; three donors received a cell-saver blood transfusion. Intraoperative fluid replacement was with crystalloids, colloids and 4% albumin. Total urine output was 1,472 (700-3100)mL. Although intraoperative hypothermia occurred all subjects were normothermic at the end of operation. The pre- and immediately postoperative haemoglobin concentration averaged 13.6 (9.8-15.6) and 10.5 (6.9-13.0)gdL(-1), respectively. On the first postoperative day, the haemoglobin was 11.7 (8.4-15.1)gdL(-1). The donors' liver function tests were transiently elevated in the initial postoperative period. The intensive care unit discharge time was 2 (1-3) days. The hospital stay was 13 (7-17) days. There was no morbidity or mortality. The study demonstrates that right-lobe living-donor surgery was well tolerated, without intraoperative hypotension or haemodynamic instability, without perioperative anaesthetic or surgical complications, and with an excellent general outcome.

Anaesthetic management and outcome in right-lobe living liver-donor surgery

Background and objective: We reviewed retrospectively the anaesthetic management and perioperative course of eight right hepatectomies for living liver donation. Methods: After preoperative psychiatric evaluation, eight ASA I-II individuals donated the right lobe of their liver to a family member. A graft-recipient body weight ratio of 0.8-1.0% was required for patient selection. Indications for liver transplantation were: hepatitis C viral-related cirrhosis in six patients; combined hepatitis C and B viral cirrhosis in one patient; multifocal hepatocellular carcinoma - four lesions, involving both liver lobes - of hepatitis C viral-related cirrhosis in another patient. Indication for adult-to-adult living-donor liver transplantation was retained in the latter because of rapid deterioration of liver disease, rare recipient's blood group and extended, unresectable hepatocellular carcinoma. Hepatitis C viral-related cirrhosis was casually the primary indication for adult-to-adult living-donor liver transplantation in this group. The condition of the donated hepatic lobe was optimized by appropriate drug and perfusion management. Preoperative investigations included: blood tests (full cell count and film, thyroid function tests, pregnancy tests, full virological tests and bacteriological cultures, and immunological typing), chest radiograph, electrocardiogram plus Doppler cardiac ultrasound, spirometry, aminopyrine breath test, liver Doppler examination, magnetic resonance imaging, angiography and cholangiography and a volumetric study of the whole liver and the right lobe. Haemoglobin and lactate concentrations, liver function tests and international normalized ratio were measured before and after operation. The volume and weight of the resected right lobe was calculated. Anaesthesia was induced with propofol 300 mL h−1 and sufentanil 0.3 μg kg−1 intravenously; cisatracurium, 0.15 mg kg−1, was given to facilitate tracheal intubation. Anaesthesia was maintained during normocapnic ventilation of the lungs with oxygen 40% in air, isoflurane 1-1.5 MAC and sufentanil. Routine anaesthetic monitoring included electrocardiography, pulse oximetry, invasive blood pressure, central venous pressure, urine output, state of neuromuscular blockade and core temperature. Periods of hypotension (<80% of the preoperative blood pressure) or haemodynamic instability (requiring inotropic or vasoactive support) were registered. Total blood loss and transfusion (homologous, autologous or cell-saver blood) requirements were measured; volume replacements were derived. Results: Data are presented as mean (range). There was no morbidity or mortality and no periods of intraoperative hypotension or haemodynamic instability. The operation time averaged 619 (525-780) min. Four donors were extubated in the operating room immediately after surgery; the others were extubated in the intensive care unit, where the mean extubation time was 16.3 (5-25) h after arrival. The estimated blood loss was 967 (550-1600) mL. No homologous blood was administered; five donors received autologous blood, intraoperatively; three donors received a cell-saver blood transfusion. Intraoperative fluid replacement was with crystalloids, colloids and 4% albumin. Total urine output was 1472 (700-3100) mL. Although intraoperative hypothermia occurred all subjects were normothermic at the end of operation. The pre- and immediately post-operative haemoglobin concentration averaged 13.6 (9.8-15.6) and 10.5 (6.9-13.0) g dL−1, respectively. On the first postoperative day, the haemoglobin was 11.7 (8.4-15.1) g dL−1. The donors' liver function tests were transiently elevated in the initial postoperative period. The intensive care unit discharge time was 2 (1-3) days. The hospital stay was 13 (7-17) days. There was no morbidity or mortality. Conclusions: The study demonstrates that right-lobe living-donor surgery was well tolerated, without intraoperative hypotension or haemodynamic instability, without perioperative anaesthetic or surgical complications, and with an excellent general outcome.

Impact of a remote pump head on neonatal priming volumes.

Reduction of priming volumes of the cardiopulmonary bypass (CPB) circuit in neonatal cardiac surgery to decrease haemodilution and blood transfusion requirements can be achieved with the use of neonatal low prime oxygenators and smaller diameter tubing. We have further reduced our prime volume with the use of a custom-designed arm allowing for remote positioning of a double-headed roller pump. This arm enables the double pump to be placed alongside the main heart-lung machine close to the operating table, and to position the pump inlet and outlet tubing immediately at the reservoir outlet and oxygenator inlet, respectively, therefore reducing tubing lengths. Priming volumes of four cases using this configuration were compared to four cases using our standard neonatal bypass setup. Results showed a 29% decrease in priming volume and a 58% reduction in blood utilization during CPB. This reduction in priming volume is clinically significant as it lowers the ratio of priming volume to patient blood volume and reduces homologous blood requirements.

PERIOPERATIVE BLOOD LOSSES AFTER TOTAL HIP REPLACEMENT (THR)

S262 CB is effective to relieve pain after THR. [1] Its influence on blood losses after hip surgery has not been studied. Epidural anesthesia significantly reduces intraoperative blood losses after THR. [2] The aim of this study was to compare the effects of CB, EA and IV PCA on perioperative blood losses and blood requirements after elective THR. METHODS: After informed consent and institutional approval, 45 ASA class 1-3 patients scheduled for elective THR under general anesthesia were included in this study. They were randomly divided into three groups of 15. They received no block in group A, CB prior surgery in group B and EA in group C. CB was performed following Winnie's landmarks. [3] A 20G catheter was threaded 10-15 cm into the psoas compartment and 40 ml 0.25% bupivacaine with epinephrine 1/200000 were injected and followed by a continuous infusion of 0.125% bupivacaine at 10 ml/hour during 48 hours. EA was performed at L2-L3 or L3-L4 level. A 18G catheter was threaded 4-5 cm into the epidural space and 10 ml 0.25% bupivacaine with epinephrine 1/200000 and 10 [micro sign]g sufentanil were injected and followed by the same continuous infusion. In group A, postoperative analgesia was administered by IV PCA with morphine. During the procedure, mean blood pressure (BP) was maintained > 65 mm Hg with ephedrine. Hb level was maintained > 8 g/dl during the hospital stay. Studied variables were: intraoperative hemodynamics, Hb level preoperatively and at discharge from the hospital, measurable perioperative blood losses (suction, sponges, redons) and blood requirements. Statistical analysis was done with ANOVA and LSD test when appropriated. Results are expressed as means +/- SEM. A p value < 0.05 was considered significant. RESULTS: Population data, duration of surgery, and intraoperative hemodynamics were comparable in all groups. However, a significantly higher dose of ephedrine was required in group C (8.3 +/- 2.3 mg) when compared with groups A (1 +/- 0.6 mg) and B (2.3 +/- 1 mg) to maintain mean BP > 65 mm Hg. Other studied variables are presented in Table 1. No significant difference was noted between the groups.Table 1CONCLUSIONS: In elective THR, CB and normotensive (mean BP > 65 mm Hg) EA have no effect on total blood losses and homologous blood requirement.

Effectiveness of autologous blood donation in coronary surgery--a retrospective analysis

This study was performed to evaluate whether autologous blood donation prior to coronary artery bypass graft surgery (cabg) reduces homologous blood requirements and the risk of homologous blood transfusion. Within a period of 18 months, 633 patients undergoing cabg surgery were retrospectively included into the study. Non-donors were included if preoperative haemoglobin concentration exceeded 12.5 g%. According to demographic data, risk scores of patients who donated blood (n = 201) were lower. More patients of this group received left internal mammary bypass grafts (63% vs. 51%; p = 0.047). Nevertheless, blood loss did not differ between donors and non-donors. Prior to blood donation, haemoglobin-concentration was significantly higher in male donors (n = 177) compared to female donors (n = 24) (15 +/- 1.2 vs. 13.8 +/- 1 g%; P < 0.001). Compared to female donors, male patients donated significantly more blood units. The risk of homologous blood donation was significantly lower in male donors than in male non-donors (no homologous transfusion: 20% vs. 42%; P < 0.0001; Odds Ratio: 0.34; 95% confidence-interval: 0.23-0.52). Accordingly, homologous blood requirements were lower in male donors (0.9 +/- 3.4 vs. 1.6 +/- 3.6 blood units; P = 0.02). Between female donors and non-donors neither the number of patients treated with homologous blood (no homologous transfusion: 29% vs. 33%, P = 1; odds ratio: 1.17; 95% confidence-interval: 0.4-3.4), nor the mean number of transfused homologous blood units (1.8 +/- 1.6 vs. 1.9 +/- 2.4; P = 0.83) was different. Reactions during blood donation requiring treatment (bradycardia, hypotension, angina, arrhythmias) occurred more often in female patients (5/24 vs. 9/177; P = 0.015). In our study, autologous blood donation significantly decreased the risk of homologous transfusion and homologous blood requirements in male cabg patients. We were not able to prove the efficacy of autologous blood donation in female cabg patients. Due to the small sample size of our investigation, further prospective studies are necessary to answer the question whether patients with low blood volume, body weight and body height scheduled for cabg surgery should be excluded from autologous blood donation.

The effect of preoperative recombinant human erythropoietin therapy on platelets and hemostasis in patients undergoing cardiac surgery

In a double-blind, randomized, placebo-controlled trial we evaluated the effects of the administration of recombinant human erythropoietin (5 × 500 U epoetin beta/kg body weight intravenously over a 14-day period before surgery) in patients undergoing cardiac surgery and in whom autologous blood donation was contraindicated on platelet count, platelet distribution width, mean platelet volume (MPV), and certain hemostaseologic parameters. All patients received 3 × 70 IU heparin/kg per day s. c. from 2 days before operation. No thromboembolic events were associated with epoetin beta therapy during the study period. The thrombocytic parameters showed no significant changes in the placebo group before surgery, and the preoperative hematocrit increase in the epoetin beta group was accompanied with an MPV drop (in contrast to the known MPV rise in recombinant human erythropoietin-treated patients with uremia) by a mean of 0.85 fl and a platelet distribution width rise by 3.3% without a significant change in platelet count. In the epoetin beta group the coagulation time (K) of thromboelastogram (TEG) showed an increase from 4.8 to 5.4 minutes by the seventh study day and after the initiation of heparin therapy a further increase to 7.5 minutes. The higher preoperative K increase in the epoetin beta group may partly be a result of the MPV reduction, because smaller platelets are less reactive, a fact underlined by the negative correlation between the preoperative changes of MPV and reaction time of TEG ( r = −0.58, p = 0.0148). In contrast, in the placebo group the K of TEG increased only after the start of heparin therapy (from 5.1 to 6.4 minutes). The significant drop in MPV in the epoetin beta group and the higher increase in K of TEG and the other investigated hemostatic parameters do not suggest any increased thromboembolic risk during the preoperative epoetin beta therapy. Therefore this treatment seems to be a safe way for increasing mean hematocrit by approximately 0.06 within the normal range and reducing the homologous blood requirement in patients undergoing elective cardiac surgery.

Effect of High-dose Aprotinin on Postoperative Homologous Blood Requirement in Adult Cardiac Surgery

Effect of High-dose Aprotinin on Postoperative Homologous Blood Requirement in Adult Cardiac Surgery