Preoperative Autologous Blood Donation Research Articles

Prise en charge périopératoire des pertes sanguines au cours du traitement chirurgical des craniosténoses

Blood saving is the major challenge during the surgical repair of craniofacial deformities. Treated patients have a low reserve volume and the techniques available to lower homologous blood transfusions are limited or insufficiently evaluated in this particular case. The most important factor determining blood loss is the quality of the surgical haemostasis. Blood saving begins with early preoperative evaluation of the patient’s bleeding risk, which is a function of the type of surgery, of the surgical technique, of the number of sutures involved, of the length of surgery, and of the patients age, weight and physical status. Elaborated blood saving techniques such as preoperative autologous blood donation, erythropoietin administration, normovolaemic haemodilution, and peroperative autologous blood saving and reinfusion have revealed disappointing where used alone. These techniques require a heavy setup and still need to be evaluated extensively. They should be used in selected cases such as in patients with a very high risk of bleeding or face to Jehovah Witnesses. Monitoring during surgery should include precise evaluation of blood losses and haematocrit measurements at regular intervals. The haematocrit threshold allowing homologous blood transfusion should be set at 21%, provided that any other source of autologous blood is exhausted. Postoperative monitoring should also include precise evaluation of blood losses and haematocrit measurements. The 21% threshold should remain the reference during that period.

Rational Medical Decision Making Improves Efficacy and Cost-Efficiency in Autologous Transfusion: Preoperative Autologous Blood Donation, Perioperative Blood Salvage with Mechanical Processing, and Preoperative Autologous Plasmapheresis

Background: Restrictions in reimbursement rates urge physicians to critically reconsider their routine clinical practice. This study analyzes the effects resulting from changes of an autologous transfusion concept (ATC) with respect to efficacy and cost-efficiency. Patients and Methods: In concept one (CI), the former ATC, i.e. preoperative autologous blood donation (PABD), autologous plasmapheresis (APPH) to harvest autologous fresh frozen plasma (AFFP), and perioperative blood salvage with mechanically processed autologous transfusion (MAT), were applied routinely to patients undergoing elective major bone and joint surgery. In concept two (CII), the present ATC, PABD, and MAT were applied only if an increase in RBC mass (+RBC) of at least 1 RBC unit (190 ml) was expected. APPH was cancelled. Analysis considered direct/variable cost (d/v C), including disposables, consumables, volume substitution in PABD and APPH, type, screen and infectious/serological testing (PABD). Identical measures in CI and CII caused identical d/v C (PABD: EUR 36.05 per 1 PABD and EUR 60.10 per 2 PABDs; MAT: EUR 188.10 per patient; APPH: EUR 89.10 per patient). Results: Compared to CI, the total number of PABDs in CII increased by 62.9% (from 3,110 to 5,065) – i. e. from 1 PADB to 1.95 PABDs per patient (+95%) –, thereby causing an increase in total d/v C by EUR 40,087.– (35.8%) (from EUR 112,116.– to EUR 152,203.–). These changes together with an additional increase in the time interval between first PABD and surgery from 14 to 36 days caused an increase in total RBC regeneration by 151.3%. With respect to the individual patient, RBC mass increased by 208% (from 81 ml per patient in CI to 250 ml per patient in CII). This +RBC equaled 2,006 U of RBC. Net improvement of cost-efficiency amounted to a total of EUR 89,468.–. Compared to CI, the number of MAT sets consumed in CII decreased by 30.6% (from 2,690 to 1,866), resulting in a decline in total d/v C by EUR 154,994.– (from EUR 505,989.– to EUR 350,994.–). The number of MAT cycles per patient increased from 1.98 to 2.54, resulting in an increase in RBC recovery by 63 ml per patient (from 223 to 286 ml) and an improvement of cost-efficiency by approximately 22%. These changes equaled to net savings in d/v C of EUR 207,420.–. Contrary to CI, APPH was cancelled in CII, and thereby d/v C were reduced by EUR 468,289.–. Replacing AFFP for volume substitution by an artificial colloid, net savings in total d/v C equaled still to EUR 413,962.– (88.4%). When considering AFFP to be given for coagulation reasons in 20% and for volume substitution in 80%, savings in d/v C still amounted to EUR 237,469.– (50.7%). Altogether, the improvement of cost-efficiency resulted in savings of d/v C of EUR 534,357.–. Total fixed cost did not change. Conclusion: Rational medical decision making in autologous transfusion improved both efficacy and cost-efficiency solely by adapting these blood conservation measures to physiologic basics of erythropoiesis and by applying AFFP exclusively for coagulation reasons.

Safety of Preoperative Autologous Blood Donations in Cardiac Surgery

Background: The aim of this study was to assess the safety of preoperative autologous blood donation (PABD) during cardiac surgery. Methods: 64 patients undergoing first-time elective cardiac surgery were prospectively followed up during PABD before cardiac surgery. Three blood donations in weekly intervals were performed, and all patients received oral (350 mg/day FE+) or i.v. iron (150 mg /week) supplementation. In addition there were 2 subgroups receiving recombinant human erythropoietin (rh-EPO; 10,000 U s.c.) during each donation. 24 patients without PABD served as controls. Results: All patients tolerated the three PABDs before cardiac surgery without any major adverse events or complications. Hemodynamic parameters (heart rate and blood pressure) showed a decrease of less than 10% after donation. On the visual assessment scale, less than 10% of the patients indicated discomfort. None of the patients required rehospitalization or additional treatment in the donation phase before surgery. Conclusion: PABD before cardiac surgery is feasible and safe. No differences could be found between peroral and i.v. iron supplementation. The subgroups receiving rh-EPO showed smaller decreases in hemoglobin level before surgery than the placebo groups. Thus, we can recommend PABD before cardiac surgery if strict selection criteria and an optimal monitoring of the patient during donations are met.

Facteurs associés à la stratégie transfusionnelle au cours des anesthésies programmées pour arthroplastie de hanche ou de genou en France

Goal of the study: To determine over a whole country what are the factors associated with an intraoperative homologous blood transfusion and with the use of autologous techniques (preoperative autologous blood donation : PABD; acute normovolemic hemodilution: ANVH; intraoperative red cell salvage: IRCS). Study design: National enquiry using a large representative sample (3 days of anaesthesia in France). Methods: Univariate followed by multivariate analyses of data gathered in 1996 during the survey leaded by the French society of anaesthesia and intensive care (Sfar) and corresponding to 884 scheduled hip and knee prosthesis surgical procedures. Results: Factors associated with a decreased use of PABD programme were: 1- old age and high ASA physical status; 2- procedures of short duration. By contrast, an increased use of PABD was associated with anaesthetics in which a closed circuit had been used. Except for a significant association with increasing age and with absence of PABD used, no additional factor was found to be linked with ANVH. No factor among those studied was found related to the use of IRCS. Homologous blood transfusion was more frequently used in ASA ≥ 3 patients, in long duration surgeries while its use was decreased in patients with PABD (odds ratio for reduction by PABD : 4.4 〚95 % confidence interval : 2.2-8.8〛). Homologous blood transfusion was not related to the use of ANVH or IRCS. Conclusion: These data obtained from a large national survey confirm previously published studies and meta-analyses and are in agreement with current recommendations. An unexpected relation between PABD and closed circuit anaesthesia has been found.

心拍・血圧変動スペクトル解析を用いた自己血採血および輸液後の自律神経機能の評価

Reducing vasovagal reactions (VVR) may have a beneficial impact on blood donor safety. The purpose of this study was to analyze the immediate response of autonomic activity during autologous blood donation (ABD). We investigated 30 patients who required preoperative ABD. To assess the respective contributory roles of the major reported variables (weight, gender, and donation status), spectral analysis of heart rate and systolic blood pressure variability was performed. Three phases were defined as follows: resting phase, after ABD, and after crystalloid or colloid infusion. Surface ECG and blood pressure were monitored continuously and R-R interval (RR) and systolic blood pressure (SBP) were analyzed. Discrete data with the modified head-up tilt (from supine to sitting position) test were analyzed using the MemCalc system. The power spectrum was integrated into two major components: a high frequency component (HF) from 0.15 to 0.40Hz and a low frequency component (LF) from 0.04 to 0.15Hz. HF is the specific index of cardiac parasympathetic tone (HF-RR). Further, the ratio of LF to HF (LF/HF-RR) was calculated as a marker of sympathetic activity. The low-frequency component of SBP (LF-SBP) is influenced by sympathetic activity of the peripheral arteries. Excluding the male group, HF-RR increased after ABD with sitting, indicating a shift in sympathovagal balance toward parasympathetic predominance. In females and first-time donors, LF-SBP was significantly increased after ABD. It is suggested that these groups have higher risk of VVR than other groups, given that transient sympathetic activation is reported as a primitive neurogenic shock reaction. After an infusion, parasympathetic predominance returned to the normal, and no significant differences were observed between the colloid solution and crystalloid solution groups. These results suggest that ABD carries a risk of VVR for all patients, especially females and first-time donors, and that infusion may be one of method of preventing VVR.

Is There Still a Place for Autologous Blood Predonation?

SUMMARYInterest in autologous blood procurement was stimulated in the 1980s by a renewed awareness that infectious diseases, including post‐transfusion hepatitis and human immunodeficiency virus (HIV), are transmissible by blood transfusion. Preoperative autologous blood donation (PAD), acute normovolemic hemodilution (ANH), and intraoperative/postoperative autologous blood cell recovery and reinfusion were each techniques identified and promoted in the surgical arena in response to medical and legal pressures to minimize allogeneic blood exposure.The role of autologous blood procurement in surgery continues to evolve based on improved blood safety, increased blood costs, and emerging pharmacologic alternatives to blood transfusion. PAD became accepted as a standard practice in certain elective surgical settings, such as total joint replacement surgery, so that by 1992, over 6% of the blood transfused in the U.S. was autologous. In contrast, ANH was rarely practiced and published data regarding its merits were scant. Subsequently, substantial improvements in blood safety were accompanied by a decline in PAD (Table 1) as well as by an interest in ANH as an alternative, lower‐cost autologous blood procurement strategy. Nevertheless, public perception of blood safety and the reluctance to accept allogeneic blood transfusion in the elective transfusion setting, along with emerging blood inventory shortages, continue to make the application of autologous blood procurement strategies a subject of ongoing debate. The current roles of these strategies are presented.

ESTIMATED BLOOD LOSS AND TRANSFUSION REQUIREMENTS OF RADICAL CYSTECTOMY

Radical cystectomy has been associated with significant blood loss and/or transfusion requirement. We defined and characterized blood loss and transfusion parameters in this population. We reviewed the records of 304 consecutive patients who underwent radical cystectomy and urinary diversion between October 1995 and July 2000. Charts were examined, and univariate and multivariate logistic regression analysis was performed to evaluate estimated blood loss and the transfusion requirement. Complete blood loss data were available in 297 cases. Overall 45% of patients had anemia preoperatively. Median estimated blood loss was 600 ml. (range 100 to 3,000). On univariate analysis increased estimated blood loss was related to patient age, American Society of Anesthesiologists score, longer operative time and paralytic ileus. Overall transfusion was done in 88 of 297 cases (30%) with a median requirement of 2 units (range 1 to 10). The transfusion rate in male and female patients was 26% and 40%, respectively (p <0.05). On univariate analysis female gender, ileal conduit diversion and lower preoperative hematocrit correlated with transfusion need (p = 0.04, <0.001 and <0.001, respectively). On multivariate logistic regression analysis lower preoperative hematocrit, increased estimated blood loss, major complications and ileal conduit diversion type correlated with a higher transfusion rate (odds ratio 8.34, 5.88 and 4.60, respectively). Acute blood loss anemia is common in patients undergoing radical cystectomy, and predicting blood loss and transfusion requirements remains difficult. These data indicate the need for continued refinement in surgical techniques to decrease blood loss as well as for strategies designed to decrease the need for blood transfusion.

Efficacy of Preoperative Autologous Blood Donation

SUMMARYPreoperative autologous blood donation (PABD) is the most widely utilized autotransfusion technique. However, improvements in allogeneic blood safety and increased pressure on cost‐containment command a review of its role by analyzing the need, feasibility, efficacy and cost‐effectiveness of the procedure. Residual risks and shortages of donor blood still support the need for PABD. Experiences worldwide show that the technique has a good feasibility profile when hospital resources are appropriately organized and support its safety in the majority of the patients scheduled for elective surgery. Studies in the United States and Europe demonstrate that PABD is effective in reducing exposure to allogeneic blood. However, the cost‐effectiveness of PABD has been claimed to be poor. Thus, strategies should be adopted to reduce the direct costs of PABD, to optimize its efficacy, and to reduce the collection of unnecessary blood units. PABD should be appropriately planned in order to derive the greatest physiologic benefits from blood collections. For example, it is necessary to start PABD at least 20 days before the operation, to collect at least two units of AB (autologous blood), and to monitor the patient's iron status. A personalized approach to define the patient's transfusion requirements can facilitate the decision about enrollment in a PABD program and define the number of units to be collected from a given patient.

Cryopreservation of red blood cells using hydroxyethyl starch (HES) - From laboratory investigations to clinical application

Die Kryokonservierung von Erythrozyten (RBC) ist angebracht bei Patienten mit seltenen Blutgruppen und Problemen mit multiplen Antikörpern. Sie kann darüber hinaus angebracht sein zur Überbrückung von Engpässen bei zivilen oder militärischen Katastrophen. Zusätzlich könnte sie zu Quarantänezwecken genutzt werden. In der praktischen Routine kann die Kryokonservierung dazu beitragen, den Verfall von Eigenblutkonserven für Elektiveingriffe zu verringern. Im Gegensatz zum etablierten Kryoprotektiv Glycerin muss das Kolloid HES nach dem Auftauen nicht herausgewaschen werden. Methoden und Ergebnisse: Nach zahlreichen in vitro und tierexperimentellen Experimenten wurden bei 7 Freiwilligen die ersten Re-Transfusionen der mit dem neuen optimierten HES-Protokoll hergestellten Eigenblutkonserven durchgeführt. Therapeutisch angewendet wurde das Verfahren zum ersten Mal bei einer 16jährigen Patientin. Vor einigen Jahren wurde eine systematische klinische Phase-II-Studie abgeschlossen, die die Überprüfung der Sicherheit und Verträglichkeit von mittels HES kryokonservierten autologen Erythrozyten-Konzentraten (EK) zum Ziel hatte. Jeweils das erste (EK), das von 36 Patienten erhalten worden war, die sich einer präoperativen Eigenblutentnahme unterzogen hatten, war randomisiert 3 Gruppen zugeordnet worden. Gruppe 1: Konventionelle Flüssiglagerung bei 4° C in PAGGS-M, Gruppen 2 und 3: Kryokonservierung mittels Flüssigstickstoff und HES (MW 200.000, MS 0,5, Endkonzentration 11,5 Gewichts-%). Gruppe 2: Re-Transfusion nach Waschen der aufgetauten Konserve, Gruppe 3: ohne Waschen. Es wurden keine signifikanten Unterschiede nach autologer Re-Transfusion im Hinblick auf Hämodynamik, Blutgasparameter und Gewebsoxygenierung in den drei Gruppen gefunden. Es wurden auch keine schwerwiegenden Nebenwirkungen bei der Re-Transfusion der gewaschenen oder ungewaschenen kryokonservierten RBC gesehen. Die Ergebnisse zeigten, dass die Gabe eines mittels HES kryokonservierten autologen EK sicher ist und gut vertragen wird. Ausblick: Weitere Untersuchungen sind notwendig, um die Effekte zu untersuchen, die bei der Gabe größerer Volumina homologer, mittels HES kryokonservierter RBC auftreten können.

Evaluation of a new hydroxyethyl starch solution (HES 130/0.4) in patients undergoing preoperative autologous blood donation

Study Objective: To compare the tolerance and efficacy of the new hydroxyethyl starch (HES) 130/0.4 with a current HES solution (HES 200/0.5) in patients undergoing preoperative autologous blood donation as a model of surgical blood loss. HES 130/0.4 is expected to be a plasma substitute as efficacious as current HES solutions while offering such advantages as more complete renal elimination and reduced tissue storage. Design: Controlled, randomized, double-blind, phase II clinical trial. Setting: 1500-bed university hospital. Patients: 60 ASA physical status II and III patients scheduled for elective cardiac and noncardiac surgery, and meeting selection criteria for autologous blood donors. Interventions: Collection of 500 mL of blood with simultaneous intravenous (IV) infusion of 500 mL of either HES 130/0.4 or HES 200/0.5 (mean molecular weight 130 kD and 200 kD, degree of substitution 0.4 and 0.5, respectively). Measurements: Noninvasive measurements of heart rate and arterial blood pressure were obtained every 5 minutes until 1 hour after blood donation and infusion of the study drugs; laboratory studies (complete blood counts, electrolytes, markers of renal and liver function) were performed; and follow-up assessment of adverse events was undertaken by questionnaire 24 hours after blood donation and infusion of the study drugs. Main Results: Both hemodynamics and laboratory test results did not differ significantly between the groups at any time. Hemodynamics remained stable in each group, and no adverse event was observed in any patient until one hour after blood donation and infusion of the study drugs. Adverse events elicited by postphlebotomy questionnaire were mild and probably unrelated to HES infusion. Conclusions: Intravenous infusion of 500 mL of the new HES 130/0.4 was tolerated well and maintained cardiovascular stability in patients undergoing preoperative autologous blood donation. HES 130/0.4 proved equivalent to HES 200/0.5 in every measured respect. Its pharmacokinetic profile may render HES 130/0.4 an attractive alternative to current HES solutions.

Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion.

Public concerns regarding the safety of transfused blood have prompted re-consideration of the indications for the transfusion of allogeneic red cells (blood from an unrelated donor), and a range of techniques designed to minimise transfusion requirements. To examine the evidence for the efficacy of pre-operative autologous blood donation (PAD) in reducing the need for peri-operative allogeneic red blood cell (RBC) transfusion. Articles were identified by: computer searches of OVID MEDLINE, EMBASE, and Current Contents (to March 2001) and web sites of international health technology assessment agencies (to January 2001). References in the identified trials were checked and authors contacted to identify additional studies. Randomised controlled trials with a concurrent control group in which adult patients, scheduled for non-urgent surgery, were randomised to PAD, or to a control group who did not receive the intervention. Trial quality was assessed using criteria proposed by Schulz et al (1995) and Jadad et al (1996). The principle outcomes were: the number of patients exposed to allogeneic red blood cells, and the amount of blood transfused. Other clinical outcomes are detailed in the review. Overall PAD reduced the risk of receiving an allogeneic blood transfusion by a relative 63% (RR=0.37: 95%CI:0.26,0.54). The absolute reduction in risk of allogeneic transfusion was 43.8% (RD=-0.438: 95%CI: -0.607,-0.268). In contrast the results show that the risk of receiving any blood transfusion (allogeneic and/or autologous) is actually increased by pre-operative autologous blood donation (RR=1.29: 95%CI: 1.12,1.48). Trials were unblinded and allocation concealment was not described in 87.5% of the trials. Although the trials of PAD showed a reduction in the need for allogeneic blood the methodological quality of the trials was poor and the overall transfusion rates (allogeneic and/or autologous) in these trials were high, and were increased by recruitment into the PAD arms of the trials. This raises questions about the true benefit of PAD. In the absence of large, high quality trials using clinical endpoints, it is not possible to say whether the benefits of PAD outweigh the harms.

Erythropoietin therapy and preoperative autologous blood donation in children undergoing open heart surgery

We assessed the feasibility and efficacy of subcutaneous erythropoietin alpha (EPO) therapy and preoperative autologous blood donation (ABD) in children undergoing open heart surgery. Thirty-nine children were treated consecutively with EPO (100 U x kg(-1) s.c. three times a week in the 3 weeks preceding the operation and i.v. on the day of surgery) and two ABDs were made (Group 1). As controls to compare transfusion requirements, 39 consecutive age-matched patients who had undergone open heart surgery during the two preceding years were selected (Group 2). In a mean time of 20 (SD 5) days, 96% of scheduled ABDs were performed and only three mild vasovagal reactions were observed. The mean volume of autologous red blood cells (RBC) collected was 6 (1) ml x kg(-1) and the mean volume of autologous RBC produced as a result of EPO therapy before surgery was 7 (3) ml x kg(-1), corresponding to a 28 (11)% increase in circulating RBC volume. The mean volume of autologous RBC collected was not different from that produced [6 (1) vs 7 (3) ml x kg(-1), P=0.4]. Allogenic blood was administered to three out of 39 children in Group 1 (7.7%) and to 24 out of 39 (61.5%) in Group 2. Treatment with subcutaneous EPO increases the amount of autologous blood that can be collected and minimizes allogenic blood exposure in children undergoing open heart surgery.

The effect of preoperative donation of autologous blood on deep-vein thrombosis after total hip arthroplasty

We have assessed the effect of the donation of autologous blood and the preoperative level of haemoglobin on the prevalence of postoperative thromboembolism in 2043 patients who had a total hip arthroplasty. The level of haemoglobin was determined seven to ten days before surgery and all patients had venography of the operated leg on the fifth postoperative day. The number of patients who had donated autologous blood (1037) was similar to that who had not (1006). A significant decrease in the incidence of deep-vein thrombosis (DVT) was noted in those who had donated blood preoperatively (9.0%) compared with those who had not (13.5%) (p = 0.003). For all patients, the lower the preoperative level of haemoglobin the less likely it was that a postoperative DVT would develop. Of those who had donated blood, 0.3% developed a postoperative pulmonary embolism compared with 0.7% in those who had not, but this difference was not statistically significant. No significant difference was found in the requirements for transfusion between the two groups.

The effect of preoperative donation of autologous blood on deep-vein thrombosis after total hip arthroplasty.

We have assessed the effect of the donation of autologous blood and the preoperative level of haemoglobin on the prevalence of postoperative thromboembolism in 2043 patients who had a total hip arthroplasty. The level of haemoglobin was determined seven to ten days before surgery and all patients had venography of the operated leg on the fifth postoperative day. The number of patients who had donated autologous blood (1037) was similar to that who had not (1006). A significant decrease in the incidence of deep-vein thrombosis (DVT) was noted in those who had donated blood preoperatively (9.0%) compared with those who had not (13.5%) (p = 0.003). For all patients, the lower the preoperative level of haemoglobin the less likely it was that a postoperative DVT would develop. Of those who had donated blood, 0.3% developed a postoperative pulmonary embolism compared with 0.7% in those who had not, but this difference was not statistically significant. No significant difference was found in the requirements for transfusion between the two groups.

Comparison of Acute Normovolemic Hemodilution and Preoperative Autologous Blood Donation in Clinical Practice

Comparison of Acute Normovolemic Hemodilution and Preoperative Autologous Blood Donation in Clinical Practice

Perceptions and motivations of Canadian autologous blood donors.

Preoperative autologous blood donation in Canada has increased in the last decade due to concerns about allogeneic blood safety. As economic policies necessitate the validation of autologous blood donation, it is important to assess potential changes. This study examines the motivations and perceptions of patients participating in a Canadian autologous blood donation programme. The study was conducted at the Ottawa Hospital, Civic Campus. Questionnaires were developed and then administered to 100 consecutive adult autologous blood donors. The questionnaires assessed patient demographics, motivation for participation and perceptions about blood safety. Autologous donation was presented to 82% of patients as an option by their physicians. However, 59% of all patients felt that they were motivated to donate by their own fears. Patients (87%) also felt that directed blood donation should be offered due to their perception that directed donation is safer. Three-quarters of patients would be willing to pay for autologous donation. Patients are concerned about the safety of allogeneic blood and they are motivated to seek other alternatives despite the fact that allogeneic blood is very safe. These perceptions and motivations must be taken into account as health care policy changes are considered.

Red cell apheresis in autologous preoperative blood donation

Preoperative autologous blood donation (PAD) is a commonly used technique for elective surgical procedures with a predictable blood loss. The conventional method is to collect one unit whole blood weekly several times within the shelf-life of red cell concentrates. Erythrapheresis with the Haemonetics cell separator MCS-3p or plus ® makes it possible to collect two units of red cells in one single session and with this option the time interval and operation can be prolonged to three weeks to improve erythropoiesis. 295 patients, who were scheduled for hip replacement or knee endoprothesis were evaluated retrospectively calculating the net profit of red cells after donating two units of red cells by erythrapheresis. The median net profit of red cells was 140 ml red cells but with a wide range. The patients who profit most of PAD were those with a predonation hct below 42% who had net profits up to 300 ml red cells due to an increased erythropoiesis, which compensate for the withdrawal of the red cells. Thus erythrapheresis with the Haemonetics MCS-3p ® or Haemonetics MCS plus ® is recommended for patients with a predonation hct lower than 42% and who can be scheduled for PAD at least 3 weeks before operation when two units of red cells are the target for PAD.

The variability of compensatory erythropoiesis in repeated autologous blood donation.

Compensatory RBC production during repeated preoperative autologous blood donation (PABD) shows marked interindividual variability. This study was performed to reveal variables that might be useful to predict the amount of the erythropoietic response to PABD in an individual patient who was not iron deficient. In a retrospective study, 104 adult patients, 48 women and 56 men (mean age, 59.9 years; range, 18-82 years) who donated 3 units (450 mL) of autologous blood at weekly intervals for major surgery were investigated. Blood counts, ferritin, and net preoperative RBC production (net RBC production) were determined in all patients, and soluble transferrin receptor and endogenous levels of EPO, SCF, and IL-1beta were measured in 63 patients. Multiple linear regression analysis was used to determine whether the variance of net RBC production was attributable to baseline values of these variables. Net RBC production was not different in patients who received oral iron and patients who did not (384 +/- 222 mL vs. 356 +/- 158 mL). In both groups, the same two variables consistently showed a significant relationship to net RBC production: the length of the period between the third donation and the last visit was positively related (p = 0.00001 vs. p = 0.0002) and the Hct at baseline was negatively related (p = 0.0002 vs. p = 0.02) with net RBC production. The proportion of variance in net RBC production that was attributable to these two variables was 48.1 percent (r(2) = 0.481) and 34.9 percent (r(2) = 0.349), respectively. RBC production after PABD increases with increasing interval from last donation to surgery. This suggests that the interval from last donation to surgery should be maximized. This can be achieved by organizational measures in combination with the preparation of RBC concentrates in additive solution with a maximum shelf life.

Preoperative autologous blood donation by elderly patients undergoing orthopaedic surgery.

To assess the feasibility of a programme of predeposit in elderly patients undergoing elective orthopaedic surgery. We retrospectively studied 789 elderly patient candidates (> 65 years of age) for orthopaedic surgery (total hip and knee replacement and spinal surgery), who were undergoing a programme of preoperative autologous blood donation (PABD) in our city hospital between January 1990 and December 1998. Six hundred and eighty-eight patients (87.2%) were transfused with autologous blood; 128 (16.2%) also received allogeneic blood. Hip arthroplasty revision was characterized by the greatest blood consumption. The predeposit programme was discontinued in 96 patients (12.2%) because of the following complications: the onset of anaemia (11.0%); vasovagal reactions (0.5%); lack of venous access (0.4%); or cardiac complications (0.2%). No episodes of reaction to autologous transfusion were recorded. Our study confirms the feasibility of PABD in elderly patients undergoing elective orthopaedic surgery.

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.