Predeposit Autologous Donation Research Articles

The use of predeposit autologous donation: Guideline prepared by the BSH Blood Transfusion Task Force.

The use of predeposit autologous donation: Guideline prepared by the BSH Blood Transfusion Task Force.

Autologous versus allogeneic blood transfusion: A comparative study of the peri-operative outcomes in a tertiary care hospital in South India amidst the COVID-19 pandemic

Autologous blood transfusion is known to have advantages over allogeneic transfusion. The COVID-19 pandemic intensified the already existing shortage of allogeneic blood supply. We carried out a study during this period with the aim to elicit the effects of autologous blood collection and transfusion, to compare the peri-operative outcomes of autologous and allogeneic transfusion practices and also to assess the influence of the autologous transfusion programme in the Blood Centre inventory. It was prospective observational comparative study among neurosurgical and vascular surgical patients in a tertiary care centre in South India. 141 patients were allocated into Group I (n = 71) who received autologous transfusion and those who received conventional allogeneic transfusion were clustered as Group II (n = 72) for analysis. We employed Acute Normovolemic Hemodilution (ANH), Pre-deposit Autologous Donation (PAD) and Intra-operative Cell Salvage (ICS) as various modalities for autologous blood collection. In our study, 43 (60.6%) from Group I received exclusive autologous blood transfusion, whereas 28 (39.4%) required additional allogeneic transfusion. No significant difference in hemoglobin, hematocrit, platelet count and INR were observed between the groups post transfusion. Significant difference was observed in the thoracoabdominal aortic aneurysm (TAAA) patients with respect to duration of ICU stay (2.7 ± 1.1 days in Group I and 6.2 ± 0.8 days in Group II; p = 0.002) and re-exploration due to bleeding (16.7% in Group I and 40% in Group II; p = 0.048). Autologous blood transfusion is safe and effective. It can be employed as routine practice and also during any acute shortage or pandemic.

English

Autologous blood transfusion meaning “collection and reinfusion of the patient’s own red blood cells” has been known to mankind since the time of Philip Physic of Philadelphia who in 1785 transfused the blood collected from post-partum bleeding patient. The first documented autologous transfusion was done by Blundell in 1818 by salvaging vaginal blood during post-partum hemorrhage. The technique employed was rather crude, it marked the beginning of the “Era of Autologous Blood transfusion”. Autologous blood transfusion is justified for two reasons mainly, the prevention of allogeneic blood transfusion reactions and conservation of rare blood group types. There are four types of autologous transfusion. The pre deposit autologous donation, intra operative cell salvage, postoperative cell salvage, acute normovolaemic hemodilution. Each variety has advantages and disadvantages of its own but the issues which have to be borne in mind before adapting any of the technique is its feasibility, the cost effectiveness, fulfill the purpose of serving compatible blood without risking the patient’s health status especially peri-operatively. India being one of the fastest developing nations of the world with whole lot of patient load and rather much larger deficit of compatible blood to patient should harvest health resources in improvising the technology and feasibility of autologous blood transfusion.

Challenges of meeting the future blood transfusion requirement in England and Wales. Autologous blood transfusion could become an adjunct to the UK blood transfusion program in the future

SUMMARY As a resource, allogeneic blood has never been more in demand than it is today. Escalating elective surgery, an aging population, periodic shortages arising from a fall in supply, old and emerging threat of transfusion-transmissible infections and spiraling costs because of various safety introductions have all conspired to ensure that allogeneic blood remains very much a vital but limited asset to the National Health Service. However, there are increasing demands for alternatives/complementary strategies to allogeneic blood transfusion. Autologous transfusion, predeposit autologous donation, acute normovolemic hemodilution and perioperative cell salvage is reliable, cost-effective, safe, does not involve type and screen, not associated with isoimmunization to foreign proteins, is indicated in patients with rare blood groups or complex red cell antibodies, comes handy for some religious sect like the Jehovah's Witnesses as well as being suitable in a significant number of patients undergoing elective surgeries. Autologous transfusion improves postoperative microcirculation, tissue perfusion and reduces the risk of thromboembolism. Benchmarking transfusion activity, ensuring that it is clinically indicated and justified, will help eliminate inappropriate use of blood products and help conserve our allogeneic blood stock. Erythropoietin (EPO) has drastically and significantly altered red cell transfusion practices. There might be many patients groups who would benefit from the use of EPO analogues and thus help conserve the allogeneic blood stock for patients in whom EPO is contraindicated. There is need to formulate policies on ways to seriously and innovatively attract and retain new donors. The National Blood Service and indeed the Department for Health can do well by promoting the use of autologous blood and other alternatives therapies to complement the UK allogeneic blood transfusion program in a bid to solving the periodic and envisage future shortages in allogeneic blood particularly with an aging UK population and increasing concerns about safety arising from old and emerging transfusion-transmissible infections. This will maximize the use of the limited allogeneic blood resource particularly for patients in whom autologous blood transfusion is contraindicated.

Pre‐operative predeposit autologous donation in children presenting for elective surgery: a review

Predeposit Autologous blood donation (PAD) in children decreases the life-time complications associated with allogeneic blood. These complications include transmission of known or unknown pathogens and alloimmunization against future blood transfusions, organ transplants and pregnancies. In view of the potential long term benefits of PAD should it be considered a component of paediatric blood conservation programs. This paper reviews the literature to explore the risk of benefit analysis of adopting PAD in paediatric practice.

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.

Survey of autologous blood transfusion activity in England (2001).

Better Blood Transfusion' (Department of Health (1998) HSC 1998/224) stressed the need for National Health Service Trusts to explore the feasibility of autologous blood transfusions and raise patient awareness of these techniques. The development of an appropriate strategy to promote autologous transfusion requires an understanding of current use, along with constraints to increasing practice. Past surveys have shown unchanging attitudes to autologous transfusion (Torrella et al. (2001) Transfusion Medicine, 11, 15-19), but detailed information regarding the extent of autologous transfusion in England and North Wales was not available. This survey, carried out in 2001, considered autologous transfusion under four headings: predeposit autologous donation, acute normovolaemic haemodilution, intra-operative cell salvage and postoperative cell salvage. Questionnaires were returned from 265/310 (85.4%) hospitals served by the National Blood Service. Sixty per cent of respondents performed at least one autologous technique, although practice was limited to a few clinicians within each hospital. Predeposit donation was the most widespread technique but involved very few patients. Intra- and postoperative cell salvage techniques were practised in fewer hospitals but on many more patients. The main constraints to increasing use of autologous techniques were perceived to be logistical, but removal of constraints may only result in small increases in individual practice. More clinicians need to be encouraged to utilize appropriate, evidence-based autologous techniques.

Predeposit autologous blood donation.

Predeposit autologous donation for elective surgical procedures during which there is a potential requirement for transfusion is medically proven as safe and efficacious but significantly underutilized. The primary advantages are avoidance of transfusion-transmitted disease and alloimmunization. Appropriate donor selection is essential. In general, there are no age or weight limits for donors. The incidence of adverse reactions is no greater in properly selected autologous donors than in homologous donors. Administration of oral ferrous sulfate allows many patients to meet all of their perioperative transfusion requirements. The blood is usually stored in the liquid state, but can be frozen. The mere availability of autologous blood is not an indication for its reinfusion. The criteria for transfusion are similar to those for homologous blood. However, a more liberal interpretation may be appropriate in some clinical situations. The issue of disposition of predonated blood which is not transfused to donor-patients remains unresolved. In some areas all units are discarded. In others, the blood can be administered to other patients if the donor met all the criteria for homologous donors and the blood tested negative for infectious disease markers.