Need For Homologous Transfusion Research Articles

Normovolumetric Haemodilution and Auto Transfusion in Major Operations Prevents Transfusion- Related Complications

Objective: To assess the efficacy and safety normovolumetric haemodilution and auto transfusion in patients undergoing major surgical operations. To compare the outcome differences between normovolumetric haemodilution and auto transfusion with allogenic transfusion group. Methods: The number and intensity of transfusion related complications in 36 patients, who received normovolumetric haemodilution and auto transfusion were compared with 36 patients who received similar amount of allogenic blood in the similar clinical environment and situation. The number and intensity of the complications encountered in study and control groups were compared and evaluated. Results: The study revealed statistically significant reduction in number and frequency of transfusion related complications in the study group comparing with the control group. The study also demonstrated reduction in number and intensity of surgery and anesthesia related complications compared with the control group without detection of harmful effect of haemodilution and auto transfusion. The study group also had statistically insignificant shorter hospital stay comparing with control group. Conclusion: Autologous transfusion with normovolemic haemodilution appears to be a safe and feasible method of reducing the need for homologous transfusion. Transfusion-related complications were significantly fewer in the autotransfusion group in comparison with allotransfusion, in patients undergoing major operations. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 547-552

Hemodiluição normovolêmica aguda em cirurgias de deformidade da coluna

ObjectiveTo prospectively compare clinical and laboratorial aspects of patients undergoing spine deformity surgery using acute normovolemic hemodilution technique with tranexamic acid vs. a control group with tranexamic acid only. Evaluate the influence of hemodilution in intraoperative bleeding and the need for homologous transfusion. MethodsComparative prospective study between acute normovolemic hemodilution technique associated to tranexamic acid and tranexamic acid only (15 mg/kg) in patients undergoing spine deformity surgery. Age ranged between 12 and 65 years. Laboratorial exams were analyzed in three different moments. ResultsThirty patients were included in the present study, with 17 in the hemodilution group and 13 in the control group. Mean duration of surgery in the hemodilution group was longer. The number of levels submitted to surgery ranged from seven to16 in the hemodilution group, vs. four to 13 in the control group. There was more intraoperative bleeding in the control group. All patients were stable during the procedures. Only six participants needed homologous blood transfusion, mostly from the control group (p > 0.05). ConclusionThere was no significant difference between the two groups regarding the need for blood transfusion and intraoperative bleeding. The severity of the deformity was the main determinant of homologous blood transfusion.

Does mechanical filtration of intraoperative cell salvage effectively remove titanium debris generated during instrumented spinal surgery? An in vitro analysis

Background contextInstrumented fusion of the spine is a surgery commonly performed to stabilize vertebrae causing pain and to correct anatomic deformities. Such surgery can create substantial blood loss. Autotransfusion is a means to limit homologous blood transfusion in this setting. However, a dilemma is created when the high-speed drill used for bone removal comes in contact with implanted titanium spinal hardware. A clinician at this point is forced to decide between two options: to discontinue autotransfusion to avoid the potential transfusion of titanium fragments while risking blood loss and the need for homologous transfusion or to continue autotransfusion while risking transfusion of titanium fragments back into circulation. PurposeTo conclusively identify whether titanium fragments created by a high-speed drill are able to pass through standard autotransfusion microaggregate blood filters. Study designA positive and negatively controlled experiment with blinded sample analysis. Outcomes measuresThe presence or absence of titanium alloy on a filter with detection by energy-dispersive X-ray spectroscopy (EDX). MethodsA mock autotransfusion setup was devised for in vitro filtering. Six investigational and two control experiments were conducted. Titanium fragments generated by a high-speed drill were aspirated with saline and filtered with standard autotransfusion reservoirs and microaggregate blood filters. A final filter with a 1-μm pore size was placed distal to the blood filters. After filtration was complete, this final filter was analyzed using EDX. ResultsThe presence of titanium was confirmed by EDX on five of six investigational filters. The positive and negative control filters were analyzed by EDX and tested positive and negative, respectively, for titanium. ConclusionsStandard 40 μm reservoir and blood microaggregate filters do not eliminate the smallest fragments of titanium generated by contact between a high-speed drill and a titanium hardware. The mass of titanium able to elude filtration is very small. The impact of transfusing blood contaminated with such a small mass of titanium is not known.

Tranexamic Acid Diminishes Intraoperative Blood Loss and Transfusion in Spinal Fusions for Duchenne Muscular Dystrophy Scoliosis

Retrospective review of intraoperative blood loss and blood replacement. We compared intraoperative blood loss and blood replacement during spinal fusion surgery for scoliosis in Duchenne muscular dystrophy (DMD) performed with and without the synthetic antifibrinolytic agent tranexamic acid (TXA). High levels of intraoperative blood loss are widely documented in DMD patients undergoing posterior spinal fusion for scoliosis. The effect of the antifibrinolytic agent tranexamic acid on decreasing the blood loss has not been studied in a large group of DMD patients. All 56 DMD patients underwent posterior spinal fusion with the same technique using 2 rods and multiple sublaminar wires. TXA was not used in 36 patients and was used in 20. In the respective groups, the age at surgery (14 vs. 13.9 years), the preoperative deformity (45 degrees vs. 51 degrees ), the mean number of levels fused (14.3 vs. 14.7), and the mean surgical times (446 minutes vs. 459 minutes) were similar. TXA dose was 100 mg/kg in solution over 15 minutes before incision followed by an infusion of 10 mg/kg per hour during surgery. Standardized measurements of intraoperative blood loss were used and calculated to compare total amount of blood loss in milliliters per patient and blood loss as a percentage in relation to estimated blood volume [estimated blood loss (EBL)/estimated blood volume (EBV) x 100]. The EBV was calculated to be 70 mL/kg (body weight). Mean blood loss with TXA was 1944 +/- 789 mL (range, 760-4000 mL) and without TXA was 3382 +/- 1795 mL (range, 600-9580 mL) (P < 0.001). Blood loss with TXA decreased by 42% compared with those not treated with TXA. Accounting for patient weight and estimated blood volume, mean % blood loss with and without TXA was 47% +/- 28% versus 112% +/- 67% (P < 0.001). This physiologic indicator shows that blood loss with TXA decreased by 58% compared with those patients not treated with TXA. TXA was also found to reduce blood loss after accounting for surgical time. No hypercoagulation or other complications from TXA therapy were observed. The reduced blood loss in TXA-treated patients translated into decreased blood transfusions. Transfusion of homologous whole blood and packed red blood cells in the TXA group was decreased by 46% compared with the no TXA group (mean levels, 512 +/- 470 mL vs. 955 +/- 718 mL), and transfusion of autologous cell saver blood was decreased by 42% in the TXA group (mean levels, 419 +/- 235 mL vs. 728 +/- 416 mL). TXA significantly reduces both intraoperative blood loss and the need for homologous transfusion of whole blood and packed red blood cells in DMD patients undergoing posterior spinal fusion for scoliosis.

An Update on Perioperative Blood Salvage in Cardiac Surgery

SUMMARYBlood conservation technologies are now the subject of increasing scrutiny in cardiovascular surgical care. In particular, positive outcomes in previous trials related to the collection and reinfusion of blood collected from the surgical wound (cell salvage) have now led this latter strategy to become a key component in modern surgical practice. Although intuitively attractive, there are, however, potential drawbacks relating to its usage including the risks of induced coagulopathy, infection and hemolysis. In this review, the principles and mechanics of cell salvage (processed, i.e. centrifugally washed, and unprocessed) as they relate to cardiac surgery, will be discussed. The impact of these techniques on the quality of harvested blood will be reviewed. Finally, the efficacy of this technology as a blood conservation strategy to limit the need for homologous transfusion as demonstrated in randomized clinical trials in cardiac surgery will be reviewed.

Cerebral oxygenation monitoring using near infrared spectroscopy during controlled hypotension

Controlled hypotension (CH) is used to limit intraoperative blood loss and decrease the need for homologous transfusions. Despite the efficacy of the technique, hypotension has the potential to affect cerebral perfusion and oxygen delivery. There are no data providing a direct measurement of cerebral oxygenation during this technique. The current study prospectively evaluated cerebral oxygenation during CH using near infrared spectroscopy. Nineteen patients ranging in age from 6 to 18 years were enrolled in the study. CH was provided using a combination of intravenous opioids and sevoflurane supplemented with labetolol as necessary. There were a total of 268 readings obtained from the cerebral oximeter. The baseline cerebral oximeter reading was 81+/-8% on the right and 82+/-7% on the left. During CH (mean arterial pressure of 65-69, 60-64, 55-59, and <54 mmHg), the right cerebral oximeter values were 80+/-9, 78+/-8, 78+/-10, and 84+/-9%, respectively while the left cerebral oximeter values were 79+/-7, 80+/-7, 78+/-8, and 78+/-8%, respectively. Of the 268 readings, there were 11 points (4%) at which either the left or right cerebral oximeter was 10-19 less than the baseline value and no points at which the reading was 20 or more from the baseline value. Our preliminary data with a measurement of cerebral oxygenation demonstrates the safety of CH within the accepted mean blood pressure recommendations of 55-65 mmHg.

Intraoperative red cell salvage.

In this article, Tony Fisher explores the background to autotransfusion and how recent advances in equipment and techniques have facilitated intraoperative cell salvage, thus reducing the need for homologous transfusion.

An overview of blood-sparing techniques used in spine surgery during the perioperative period.

The problems linked to blood loss and blood-sparing techniques in spine surgery have been less studied than in other fields of orthopedics, such as joint-replacement procedures. Decreasing bleeding is not only important for keeping the patient's hemodynamic equilibrium but also for allowing a better view of the surgical field. In spine surgery the latter aspect is especially important because of the vicinity of major and highly fragile neurologic structures. The techniques and agents used for hemostasis and blood sparing in spinal procedures are mostly similar to those used elsewhere in surgery. Their use is modulated by the specific aspects of spinal approach and its relation to the contents of the spinal canal. Blood-sparing techniques can be divided into two categories based on their goals: either they are aimed at decreasing the bleeding itself, or they are aimed at decreasing the need for homologous transfusion. Various hemodynamic techniques, as well as systemic and local drugs and agents, can be used separately or in combination, and their use in the field of spine surgery is reported. The level of evidence for the efficacy of many of those methods in surgery as a whole is limited, and there is a lack of evidence for most of them in spine surgery. However, several blood-saving procedures and drugs, as well as promising new agents, appear to be efficient, although their efficacy has yet to be assessed by proper randomized controlled trials.

Controlled hypotension in children: a critical review of available agents.

Due to the potential for the transmission of infectious diseases with the homologous transfusion of blood products, there has been an increased interest in measures to limit intraoperative blood loss and avoid the need for homologous transfusion during high-risk surgical procedures including spinal surgery. Controlled hypotension (also referred to as deliberate or induced hypotension), defined as a reduction of systolic blood pressure to 80 to 90 mm Hg, a reduction of mean arterial pressure (MAP) to 50 to 65 mm Hg or a 30% reduction of baseline MAP, is one technique that has been used to limit intraoperative blood loss. In the adult population, several agents have been used alone or in combination for controlled hypotension including the inhalational anesthetic agents, direct-acting vasodilators such as nitroglycerin (glyceryl trinitrate) and nitroprusside, beta-adrenoceptor antagonists, and calcium channel antagonists. Despite clinical studies that have clearly demonstrated a reduction in blood loss with controlled hypotension when compared with the normotensive state and despite potential theoretical issues with each agent, there are no definitive studies demonstrating the preferred pharmacologic agent. When considering the pediatric-aged patient, studies have reported the use of the inhalational agent sevoflurane, the alpha(2)-adrenoceptor agonist dexmedetomidine as well as various vasodilators including sodium nitroprusside, nitroglycerin, fenoldopam, and alprostadil for controlled hypotension. Sevoflurane offers the advantages of easy dosage titration, no need for an additional intravenous infusion as well as providing anesthesia in addition to controlled hypotension. Disadvantages include a slightly higher cost than some of the intravenous agents and the inability to monitor evoked potentials with high sevoflurane concentrations. Whereas sodium nitroprusside, nicardipine and fenoldopam all provide the desired level of hypotension in pediatric-aged patients, nitroglycerin was not effective in this age group of patients in one study. When comparing nicardipine and sodium nitroprusside, nicardipine offers the potential advantages of fewer episodes of excessive hypotension, less rebound tachycardia and, in one study, less blood loss. Although fenoldopam has been shown to be effective, cost issues may limit is widespread application for this technique. The pharmacologic profile of dexmedetomidine indicates that this drug has potential in controlled hypotension and clinical data are needed to define its role.

Intraoperative cell salvage in radical retropubic prostatectomy

Objectives. To investigate the efficacy and safety of intraoperative cell salvage with autotransfusion using leukocyte reduction filters in patients undergoing radical retropubic prostatectomy (RRP). Methods. Between September 1996 and March 1999, 62 patients (age range 48 to 70 years) with clinically localized prostate cancer underwent RRP with intraoperative cell salvage as the sole blood management technique. Salvaged blood was passed through a leukocyte reduction filter before autotransfusion. The 62 cell salvage patients were compared with a cohort who predonated 1 to 3 U autologous blood (n = 101). The estimated blood loss, preoperative and postoperative hematocrit, need for homologous transfusion, and biochemical recurrence rates were compared between the two groups. The progression-free survival rates were compared using the Kaplan-Meier method. Results. No difference was found in preoperative prostate-specific antigen level, pathologic stage, or estimated blood loss between the cell salvage and autologous predonation groups. The preoperative and postoperative hematocrit levels were higher in the cell salvage group (42.7% versus 39.6% and 31.3% versus 27.9%, respectively; P <0.001 for each). The homologous transfusion rates were lower in the cell salvage group (3% versus 14%, P = 0.04). The incidence of progression-free survival (prostate-specific antigen level 0.4 ng/mL or greater) was no different between the groups ( P = 0.41). Conclusions. Intraoperative cell salvage with autotransfusion using leukocyte reduction filters in RRP results in higher perioperative hematocrit levels and low homologous transfusion rates and eliminates the need for autologous predonation. Cell salvage does not appear to be associated with an increased risk of early biochemical progression after RRP.

IS PREOPERATIVE DONATION OF AUTOLOGOUS BLOOD RATIONAL FOR RADICAL RETROPUBIC PROSTATECTOMY?

We investigated differences in the rate of homologous blood transfusion and the degree of anemia to determine whether it is rational to have patients donate autologous blood before radical prostatectomy. We retrospectively reviewed the charts of 221 consecutive men who underwent radical retropubic prostatectomy performed by 1 surgeon in a 14-month period. About half of the patients donated autologous blood preoperatively. We evaluated perioperative hemoglobin, and the rate of autologous and homologous transfusion. The groups did not significantly differ in terms of demographic data, co-morbid conditions, clinical variables or hospitalization. Preoperatively mean hemoglobin plus or minus standard deviation was 13.4 +/- 1 and 14.7 +/- 1 gm./dl. in patients who did and did not donate blood, while homologous transfusion was required in 1 (1%) and 4 (3.5%), respectively (p = 0. 18). At hospital discharge anemia was more prevalent in nondonors. Of the men who did versus did not donate blood hemoglobin was less than 10 and less than 9 gm./dl. in 8.4% versus 34% (p <0.0001), and 12.5% versus 0% (p <0.0004), respectively. Our retrospective review of a cohort of patients who underwent radical retropubic prostatectomy showed no difference in homologous blood transfusion based on preoperative autologous donation status. Autologous donors had lower hemoglobin preoperatively, a higher rate of transfused units and higher hemoglobin at hospital discharge. Preoperative donation of autologous blood may not decrease the need for homologous transfusion in healthy patients undergoing radical retropubic prostatectomy.

Reduced transfusion requirements during major hepatic resection with use of intraoperative isovolemic hemodilution

Background: Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of tumor recurrence and decreased survival in some series. Isovolemic hemodilution (IH) has been utilized in cardiac, orthopedic, and major general surgery procedures to reduce the use of banked blood products. We therefore sought to determine the safety and efficacy of IH during major hepatic resection in an adult population. Methods: Thirteen consecutive patients undergoing major hepatic resection with IH were compared with 13 age- and disease-matched controls. The diseases included metastatic colorectal adenocarcinoma (8 versus 9), hepatoma (2 in each group) and other (3 versus 2); and the procedures included total (right or left) hepatic lobectomy (8 versus 11), partial lobectomy (3 versus 1) and trisegmentectomy (2 versus 1). Results: There was no significant difference in operating time, estimated blood loss, fresh frozen plasma, platelets, amount of crystalloid or colloid infused between the two groups. There was no perioperative morbidity related to IH. The use of IH resulted in a 60% reduction in mean packed red blood cells transfusion during major hepatic resection. Only 38% of patients undergoing IH required packed red cells transfusion, whereas 77% of historical control patients required allogenic transfusion. Conclusion: The use of IH reduces the need for homologous transfusion during major hepatic resection. IH is a safe technique during hepatic resection and is not associated with perioperative morbidity.

P-4-475 - Lumbar drains in instrumented spinal fusion surgery: Analysis of results

To evaluate intraoperative autologous blood collection with autotransfusion (Cell Saver) with respect to patient acceptance, risk of tumor cell co-transfusion, and risk of recurrence in patients undergoing radical hysterectomy for cervical cancer.All patients explored for radical hysterectomy between August 1991 and July 1994 were offered the use of intraoperative autotransfusion. Clinical-pathologic and transfusion-related characteristics were compared for a group of historic controls surgically treated for similar disease. The risk of tumor cell co-transfusion was assessed intraoperatively with peritoneal cytology before blood collection, and postoperatively with Cell Saver blood cytology.Ninety-eight patients were offered enrollment; four declined Cell Saver use, and 71 were acceptable for analysis. Thirty-one women (mean estimated blood loss 1338 mL) were reinfused with their own blood collected in the Cell Saver, whereas 40 patients (mean estimated blood loss 631 mL) were not autotransfused. There was no significant difference in preoperative hemoglobin concentration between groups. Cell Saver use significantly reduced the need for homologous transfusions, intraoperatively (P < .001) and postoperatively (P = .02). Historic controls (mean operative blood loss 1743 mL) were nearly four times more likely to have been transfused and three times more likely to have been transfused postoperatively than was the autotransfused Cell Saver group. The mean hemoglobin concentration at discharge was lower in the autotransfused group, 9.3 g/dL, than in the historic controls, 10.8 g/dL. Nontransfused Cell Saver blood and all peritoneal cytologies were negative for tumor cells. Three pelvic recurrences, but no disseminated disease, have been noted over a mean follow-up of 24 months: one in the autotransfused group and two in the group in which the collected blood was discarded.Cell Saver use is well accepted by patients, decreases the need for homologous transfusions, and does not appear to co-transfuse tumor cells.

Intraoperative plasmapheresis in cardiac surgery

Objective : To determine the effects of intraoperative plasmapheresis on total transfusion requirements, mediastinal drainage, and coagulation. Design : The trial was prospective, randomized, and controlled. Setting : Inpatient cardiac surgery at a university medical center. Participants : Two hundred ninety-three consecutive patients undergoing cardiac surgery requiring cardiopulmonary bypass. Interventions : Intraoperative plasmapheresis (IP) was performed in 147 patients before heparinization; platelet-rich plasma was reinfused immediately after heparin reversal. Measurements and Main Results : Mediastinal chest tube drainage during the first 12 postoperative hours was significantly less in the IP group ( p = 0.022), but no difference was noted in total postoperative blood loss between the two groups. The amount of packed red cells and fresh frozen plasma transfused to the IP group in the intensive care unit was significantly lower ( p = 0.02, p = 0.002, respectively); 51.4% of patients required no transfusion compared with the control group (34.5%) ( p = 0.006). No differences were noted for data collected in the intensive care unit in terms of the mean duratio of chest tube drainage, ventilator time, or any hematologic variables at baseline or at any subsequent time in the study. Conclusions : After cardiac surgery, intraoperative plasmapheresis reduces early postoperative bleeding and decreases the need for homologous transfusions.

Preoperative autologous blood donation and plateletpheresis in patients undergoing elective cardiac operations--factors that influence the need for homologous blood transfusion.

An increased awareness of the adverse effects of homologous blood transfusion prompted us to initiate a blood conservation program consisting of preoperative autologous blood donation and platelet-rich plasma-pheresis. We studied 120 patients who underwent elective cardiac surgery at Aomori General Hospital between January 1991 and September 1994. If their hemoglobin values exceeded 12 g/ml, 400 g of whole blood was drawn 3 times before the operation. Platelet-poor plasma was collected 10 days before the operation and platelet-rich plasma was collected the day before the operation. However, despite participation in this program, 42 of 120 patients (35%) required homologous blood transfusion perioperatively. Factors that influenced the need for homologous blood transfusion were identified retrospectively, with the following found to be significant by univariate analysis: operative procedures performed, cardiopulmonary bypass time, and the amount of autologous blood and autologous plasma donated. Although the effectiveness of our blood conservation procedure remains to be verified, it reduced the need for the transfusion of homologous blood. Thus, additional units of autologous blood are required to obviate the need for homologous transfusion in patients undergoing long cardiopulmonary bypass procedures.

Blood salvage after total hip and total knee arthroplasty.

We performed a prospective study to determine the effect of postoperative collection and reinfusion of unwashed, filtered, salvaged blood alone and in combination with preoperative predeposited blood on the transfusion requirements of 375 patients treated with a total hip or total knee replacement. 208 patients were managed with postoperative blood salvage with use of the CBC ConstaVac autotransfusion system and closed suction drainage. Another 50 patients predeposited 1-4 units of autologous blood, before the operation, in addition to postoperative blood salvage. The remaining 117 patients were used as controls and were transfused with homologous blood from the blood bank. Postoperative reinfusion of salvaged blood decreased the need for homologous transfusion after hip and knee arthroplasty (mean 2.7 units) compared to controls (mean 4.2 units). The combination of postoperative reinfusion of salvaged blood and predeposited autologous blood was associated with the lowest requirements for homologous blood transfusions (mean 1.7 units).

Radical Retropubic Prostatectomy: Limited Benefit of Autologous Blood Donation

Purpose We determine whether autologous blood donation significantly decreases the need for homologous transfusions after radical prostatectomy. Materials and Methods The effects of estimated blood loss and autologous donation on the rate of homologous transfusions were analyzed in 3 groups of 100 consecutive patients treated between 1983 and 1992. Results Overall, donors were less likely than nondonors to receive homologous blood. As median estimated blood loss decreased from 1,200 to 800 cc from groups 1 to 3 (p less than 0.05), the incidence of nondonors requiring homologous blood decreased from 62 to 11 percent and that of autologous units transfused decreased from 96 to 19 percent. Conclusions With decreasing blood loss, safe but stringent criteria for transfusion and improved safety of the blood supply, autologous donation is an inefficient method to lower the slight risk of complications following homologous transfusion during radical prostatectomy.

Intraoperative autologous blood collection and autotransfusion in the surgical management of early cancers of the uterine cervix

To evaluate intraoperative autologous blood collection with autotransfusion (Cell Saver) with respect to patient acceptance, risk of tumor cell co-transfusion, and risk of recurrence in patients undergoing radical hysterectomy for cervical cancer. All patients explored for radical hysterectomy between August 1991 and July 1994 were offered the use of intraoperative autotransfusion. Clinical-pathologic and transfusion-related characteristics were compared for a group of historic controls surgically treated for similar disease. The risk of tumor cell co-transfusion was assessed intraoperatively with peritoneal cytology before blood collection, and postoperatively with Cell Saver blood cytology. Ninety-eight patients were offered enrollment; four declined Cell Saver use, and 71 were acceptable for analysis. Thirty-one women (mean estimated blood loss 1338 mL) were reinfused with their own blood collected in the Cell Saver, whereas 40 patients (mean estimated blood loss 631 mL) were not autotransfused. There was no significant difference in preoperative hemoglobin concentration between groups. Cell Saver use significantly reduced the need for homologous transfusions, intraoperatively (P < .001) and postoperatively (P = .02). Historic controls (mean operative blood loss 1743 mL) were nearly four times more likely to have been transfused and three times more likely to have been transfused postoperatively than was the auto-transfused Cell Saver group. The mean hemoglobin concentration at discharge was lower in the autotransfused group, 9.3 g/dL, than in the historic controls, 10.8 g/dL. Nontransfused Cell Saver blood and all peritoneal cytologies were negative for tumor cells. Three pelvic recurrences, but no disseminated disease, have been noted over a mean follow-up of 24 months: one in the autotransfused group and two in the group in which the collected blood was discarded. Cell Saver use is well accepted by patients, decreases the need for homologous transfusions, and does not appear to co-transfuse tumor cells.

Autotransfusion after open heart surgery: the oxygen delivery capacity of shed mediastinal blood is maintained.

Autotransfusion of mediastinal shed blood after open heart surgery has become a common and accepted procedure in reducing the need for homologous transfusion during the last 15 years. The objectives of the present study were to investigate the oxygen delivery capacity of autotransfused shed mediastinal blood, compared to patient-blood, during cardiopulmonary bypass and in the postoperative period. Ten consecutive patients undergoing elective cardiac surgery were studied. Mediastinal shed blood was collected in the cardiotomy reservoir and retransfused during the first 18 postoperative hours. The oxygen delivery capacity of the blood to the tissues was calculated by use of the oxygen status algorithm (OSA 2.0) programme and measurement of the 2,3-diphosphoglycerate (2,3-DPG) concentration. Autotransfusion volume ranged from 450-1530 ml per patient (median 824 ml). Shed blood had a mean haemoglobin level of 8.8 g/dl and 7.4 g/dl at 1 h and 6 h of autotransfusion, respectively. There were no significant changes of 2,3-DPG concentration in the patient-blood during cardiopulmonary bypass or after autotransfusion compared to preoperative values. P50 for oxygen (3.6 and 3.6 kPa) and 2,3-DPG concentrations (5.3 and 5.1 mikromol/ml erythrocyte) in shed mediastinal blood (1h and 6h postoperatively) were not significantly different compared to patient-blood. The results demonstrate that the oxygen delivery capacity of shed mediastinal blood is maintained and that the oxygen affinity of patient-blood is not influenced by autotransfusion.

Blood transfusion for radical hysterectomy before and after the discovery of transfusion‐related human immunodeficiency virus infection

To compare the patterns of perioperative blood transfusion in patients undergoing radical hysterectomy in time periods before and after the discovery of transfusion-related human immunodeficiency virus (HIV) infection.We reviewed the medical records of all patients who underwent radical hysterectomy and pelvic lymphadenectomy at Memorial Sloan-Kettering Cancer Center during two time periods, an early period (January 1, 1980 through December 31, 1993) and a late period (July 1, 1991 through June 30, 1993). The early period preceded and the late period coincided with the era of increased awareness of transfusion-related HIV infections.One hundred twenty-eight patients underwent radical hysterectomy in the early period and 71 in the late period. In the late period, markedly fewer units of blood were transfused per patient (0.62 versus 3.5). Most patients in the early period received at least one unit (117 of 128, 91%), compared with less than half (31 of 71, 44%) in the late period. For patients who received transfusions, notably fewer received homologous blood during the late (6 of 31, 19%) versus the early period (117 of 117, 100%). Using an unpaired t test and the 95% confidence interval (CI), we found that the patients in the late period had a shorter mean postoperative length of stay (11 versus 14 days, P < .0001, 95% CI +/- 1.3) and were discharged with a significantly lower mean hemoglobin level (9.7 versus 11.4 g/dL, P < .0001, 95% CI +/- 0.35). The mean estimated blood loss was lower in the late period (756 versus 1598 mL). We defined the transfusion index as the number of units transfused per 500 mL of estimated blood loss. The mean transfusion index was significantly lower during the late period (0.38 versus 1.1, P < .001, 95% CI +/- 0.19).During the perioperative period for radical hysterectomy and pelvic lymphadenectomy, the incidence of blood transfusion at our institution has markedly decreased over the past decade without immediate adverse effects on postoperative recovery. The reasons for this are probably multifactorial. However, the contribution of increased concern about transfusion-related HIV infections must be considered. Preoperative autologous donation can notably decrease the need for homologous transfusion.