Use Of Autologous Blood Transfusion Research Articles

Effect of Preoperative Autologous Blood Storage in Major Hepatectomy for Perihilar Malignancy: A Randomized Controlled Trial.

To reappraise whether preoperative autologous blood donation reduces post-hepatectomy liver failure (PHLF) in major hepatectomy for perihilar malignancy. Autologous blood storage and transfusion are carried out to reduce the use of allogeneic blood transfusion during hepatectomy and prevent postoperative complications. However, the clinical benefit in major hepatectomy has been controversial. This randomized clinical trial included patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar malignancy. Eligible patients were randomly assigned (1:1) to undergo surgery with or without the use of autologous blood transfusion. The primary outcome was the incidence of clinically relevant PHLF (grade B/C according to the International Study Group of Liver Surgery definition). Between February 6, 2019, and May 12, 2023, 138 consecutive patients were enrolled in the study (blood storage group n=68, non-storage group n=70). Twenty-five patients who did not undergo resection were excluded; the remaining 113 patients were investigated as the full analysis set (blood storage group n=60, non-storage group n=53). Surgical procedures, operative time, and blood loss were not significantly different between the two groups. The incidence of PHLF was comparable (blood storage group n=10 [17%], non-storage group n=10 [19%]; P=0.760). There were also no between-group differences in other postoperative outcomes, including the incidence of Clavien-Dindo Grade Ⅲ or higher (72% vs. 72%, P=0.997) and median duration of hospital stay (25 vs. 29d, P=0.277). Autologous blood storage did not contribute to reducing the incidence of PHLF in patients undergoing major hepatectomy.

Impact of blood salvage therapy during oncologic liver surgeries on allogenic transfusion events, survival, and recurrence, an ambidirectional cohort study.

The use of autologous blood transfusions in oncologic surgeries is somewhat controversial due to the potential risk of disease dissemination through the salvage process. On the other hand, autologous blood transfusion can prevent the potential negative effects of allogenic blood transfusions and reduce use of valuable resources. This study included 106 adult patients who underwent oncologic liver surgery at our institution between December 2015 and June 2019. The patients were divided into two groups: the Cell Saver® group (operated between January 2018 and June 2019) and the control group (operated between December 2015 and December 2017). The Cell Saver® device was present in the operating room for the Cell Saver® group, and blood was re-transfused if a certain amount of blood loss occurred. Data analysis focused on outcomes such as blood transfusion requirements, overall survival, recurrence-free survival, hemoglobin levels, hospital stay, and complications. Patient records provided relevant information on demographics, surgery details, pathology, and outcomes for both groups. Autologous blood transfusion was found to reduce the amount of blood units needed (4.0 units (control group) versus 0.4 units (Cell Saver® group) P=0.029. Kaplan-Meier curves showed no difference for both overall survival 471.6 days (Cell Saver® group) versus 468.3 days (control group) (P=0.219) and 488.9 days (Cell Saver® group) versus 487.2 days (control group) (P=0.993) and disease-free survival (P=0.553) and (P=0.735) for primary hepatic tumours and hepatic metastasis respectively between the Cell Saver® and control groups. Overall survival regardless of the type of tumour was similar to the control group (485.4d vs. 481.9d) (P=0.503). Survival was significantly lower for minor hepatectomies (516.0d vs. 517.4d) (P=0.050) in the Cell Saver® group, major hepatectomies showed no difference in overall survival (470.2d vs. 466.4d) (P=0.868). No impact on disease recurrence was found between patients who received autologous blood transfusions versus those who did not. The use of Cell Saver® should not be avoided in oncologic surgeries of the liver. Use of Cell Saver® for major hepatectomies might be more beneficial as OS was significantly lower for the Cell Saver® group for patients who underwent minor hepactomies. Further research is needed to explain this conflicting result. Nonetheless, the use of Cell Saver® in autologous blood transfusions can reduce the use of valuable resources and the risks associated with allogenic blood transfusions.

The 48th Annual Meeting of the European Society for Blood and Marrow Transplantation: Physicians - Poster Session (P001 - P578).

Background: Bone marrow donation is a procedure that takes place in a hospital operating room. In many hospitals, autologous red cell units are collected from donor before the harvest and reinfused immediately after the donation to reduce the risk of anemia. The blood donation stimulates hematopoiesis, so it's possible that autotransfusion has an impact on number of collected cells. The aim of this study is to assess whether blood donation before the harvest has an impact on the total number of nucleated cells in the product. Methods: Study design: Most of the donors undergo preharvest autologous blood collection. The procedure was not carried out if the weight difference is greater than 30kg in favor of the donor. Until March 2020, due to COVID-19, routine blood donations for autotransfusion were suspended. This situation gave an opportunity to assess, if the donation of blood has an impact on the efficiency of BM collection and hemoglobin level in donors' blood after harvest. Bone marrow was aspirated under general anesthesia, from both pelvic bones. According to the local protocol the volume of marrow and WBC was measured during donation;if the total number of nucleated cells was sufficient, the donation was finished. The collection was also completed, if the total volume of BM reached 15 ml per kg of donor's body weight. Laboratory analyses: The blood samples for morphology analyses were taken in the day of qualification, one day before and one day after harvest. The samples of BM were taken during donation to measure number of lymphocytes. Statistics: TheMann-Whitney U-test was used to determine the significance between the cohorts. Differences with p values <0.05 were considered as statistically significant. Results: Between March and October 2020, 15 BM donations from 15 healthy donors (10 men and 5 women, median age: 35 years, range 20-49 years) were performed;these donors were not referred for autotransfusion. The control group consisted of 34 donors, who underwent harvest between January 2019 and March 2020 (23 men and 11 women, median age 25 years, range 18-41 years). Total volume collected BM was comparable in both groups (median: 1182 ml in first vs 1277 ml in control group). The level of hemoglobin on the day of qualification was similar in both group: median 15.2 g/dL for donors who had blood donation;and 15.4 g/dL, for donors not referred to autotransfusion. One day before harvest, the first group had statistically lower level of hemoglobin (median 14.1 g/dL vs 14.8 g/dL, p < 0.001), however one day after BM collection both groups were comparable (median 11.1 g/dL vs 11.5 g/dL). Total number of nucleated cells in the product was comparable in both groups: median 204 × 108 in donors referred for autotransfusion vs 219 × 108 in control group. Conclusions: Autologous blood transfusion had no impact on Hb levels in blood after BM donation and had no impact on the efficiency of BM harvest. This does not support the routine use of autologous blood transfusion for unrelated BM donors.

Identification of RNA Markers in Red Blood Cells for Doping Control in Autologous Blood Transfusion.

The World Anti-Doping Agency (WADA) has prohibited the use of autologous blood transfusion (ABT) as a doping method by athletes. It is difficult to detect this doping method in laboratory tests, and a robust testing method has not yet been established. We conducted an animal experiment and used total RNA sequencing (RNA-Seq) to identify novel RNA markers to detect ABT doping within red blood cells (RBCs) as a pilot study before human trials. This study used whole blood samples from Wistar rats. The whole blood samples were mixed with a citrate–phosphate–dextrose solution with adenine (CPDA) and then stored in a refrigerator at 4 °C for 0 (control), 10, or 20 days. After each storage period, total RNA-Seq and bioinformatics were performed following RNA extraction and the purification of the RBCs. In the results, clear patterns of expression fluctuations were observed depending on the storage period, and it was found that there were large numbers of genes whose expression decreased in the 10- and 20-day periods compared to the control. Moreover, additional bioinformatic analysis identified three significant genes whose expression levels were drastically decreased according to the storage period. These results provide novel insights that may allow future studies to develop a testing method for ABT doping.

Efficacy and safety of autologous blood transfusion during cesarean section for placenta previa: a single-center retrospective study

Background: Postpartum hemorrhage is a life-threatening pregnancy complication and we want to evaluate the safety and efficacy of autologous blood transfusion during cesarean section in women with placenta previa to deal with postpartum hemorrhage. Methods: We conducted a retrospective study concentrating on all cases of placenta previa using autologous blood recovery during cesarean section in a single-center from August 2016 to July 2018, and then grouped and compared the clinical and patient characteristics. Linear regression analysis was conducted to analyze the linear relationships between estimated blood loss and recovered autologous blood volume, recovered autologous blood volume and transfused autologous blood volume, and transfused autologous blood volume and estimated blood loss. Results: In our study, autologous blood recovery technology was used during cesarean section for 294 patients with placenta previa, and a total of 266,660 mL of blood was collected and 134,342 mL of autologous blood was transfused, saving 746 U of red blood cell suspension. Recovered and transfused blood volumes were higher in patients with suspected placenta accreta and resection of the uterus. There were no serious adverse reactions related to autologous blood recovery and transfusion. Conclusions: The use of autologous blood transfusion during cesarean section in patients with placenta previa is safe and can save blood resources.

Surgeons' Disposition on the Use of Autologous Blood Transfusion in Tertiary Hospitals in Enugu, Nigeria

Background: The need for autologous blood transfusion in our tertiary hospitals to restore patients' hemodynamics with little or no complications cannot be overemphasized. Aims: This study is aimed at assessing surgeons' challenges and patients' readiness to accept autologous blood transfusion. Materials and Methods: It was a cross-sectional study conducted at Enugu State University Teaching Hospital, University of Nigeria Teaching Hospital, Enugu, and National Orthopaedic Hospital, Enugu, from September to December 2020. A convenient sampling method was adopted in the distribution of questionnaires, and a total of 67 surgeons were enrolled in the study. Collated data were analyzed using SPSS software 21. Results: The study revealed that 60% of the respondents claimed that commercial donors were observed to be the major source of allogenic blood donation. Consequently, 34.3% and 80.6% of the respondents admitted that blood-borne transmissible infections and blood transfusion reactions, respectively, were still a challenge in their practice. The outcome from this study also showed that 59% of the respondents claimed that their patients are not knowledgeable enough to make informed decision on the use of autologous blood transfusion while 52.4% of the respondents admitted that they do not have the facility for processing autologous blood transfusion. For the surgical specialties, all were willing to prescribe autologous blood transfusion for their patients, though no statistical difference (P &lt; 0.05) exists among the specialties. Conclusion: Autologous blood transfusion has remained the mainstay as effective and safest means of blood transfusion in overall patient care; hence, surgeons should incorporate this concept into their practice to enable patients make an informed decision.

La concentration sérique de gentamicine est-elle modifiée par une autotransfusion sanguine par cell-saver après une arthroplastie totale du genou avec de l’acide tranexamique ? Un essai contrôlé randomisé

BackgroundSelf-transfusion has been proven as an effective management of blood loss after total knee arthroplasty (TKA). Considering that the high local concentration of antibiotic from bone cement is delivered intravenously through the self-transfusion process, systematic toxicity has never been evaluated. In addition, the effectiveness of self-transfusion with the routine concomitant use of other modern blood-salvage strategies, like tranexamic acid, should also be assessed. Therefore we performed a randomized study to assess: (1) the safety of self-transfusion in TKA by comparing the gentamicin concentrations resulting from the use or not of autologous blood transfusion; (2) the efficacy of self-transfusion in TKA, with the concomitant administration of tranexamic acid. HypothesisSelf-transfusion in TKA elevates the serum gentamicin concentration and the potential risk of nephrotoxicity. MethodsThe serum concentration of aminoglycosides was measured in two groups of 20 patients each, after TKA, according to the use of self-transfusion. Hemoglobin, renal function and calculated blood loss were compared at several points in time between groups. ResultsThe only time where there was a statistically significant difference in serum gentamicin, was at 48h postoperatively between groups [0.3 ug/ml±0.21, range: 0.15 to 0.72 vs. 0.14ug/ml±0.1, range: 0 to 0.35 (p=0.02)]. There were no significant differences in total blood loss [1341ml±501, range: 830 to 2230 vs. 1263ml±459 range: 840 to 2480 (p=0.67)] and need of allogeneic blood transfusion [3 units vs. 2 units] between groups. ConclusionThe use of autologous blood transfusion was found to be safe, in terms of nephrotoxicity of aminoglycosides after TKA, but it seemed to be ineffective as a blood salvage strategy, when used concomitantly with the administration of tranexamic acid. Level of EvidenceII; low powered randomized study. ClinicalTrials.gov registration numberNCT04505748.

Significant Variation in Blood Transfusion Practice Persists Following Adolescent Idiopathic Scoliosis Surgery.

Retrospective case control study. To review current transfusion practise following Adolescent Idiopathic Scoliosis (AIS) surgery and assess risks of complication from transfusion in this cohort. No study to date has investigated variation in blood transfusion practices across surgeons and hospitals following AIS surgery. Data were extracted from the Statewide Planning and Research Cooperative System. Using International Classification of Diseases (ICD-9) all patients with (ICD-9) code for AIS (737.30) ("idiopathic scoliosis") and underwent spinal fusion between 2000 and 2015 were included. Bivariate and mixed-effects logistic regression analyses were performed to assess patient, surgeon, and hospital factors associated with perioperative allogeneic red blood cell transfusion. Additional multivariable analyses examined the association between transfusion and infectious complications. Of the 7689 patients who underwent AIS surgery, 21.1% received a perioperative blood transfusion. After controlling for patient factors, wide variation in risk-adjusted transfusion rates was present with a 10-fold difference in transfusion rates observed across surgeons (4.4%-46.1%) and hospitals (5.1%-50%). Patient factors did not explain any of the surgeon or hospital variation. Use of autologous blood transfusion, higher surgeon procedure volume, and greater surgeon years in practice were independently associated with lower odds of allogeneic blood transfusion (P < 0.001), and surgeon and hospital characteristics explained 45% of surgeon variation but only 2.4% of hospital variation. Allogeneic blood transfusion was independently associated with postoperative wound infection (OR = 1.87, 95% CI = 1.20-2.93), pneumonia (OR = 1.68, 95% CI = 1.26-2.44), and sepsis (OR = 2.42, 95% CI = 1.11-5.83). Significant variation exists across both surgeons and hospitals in perioperative blood transfusion utilization following AIS surgery. Use of autologous blood transfusion and implementing institutional transfusion protocols may reduce unwarranted variation and potentially decrease infectious complication rates.Level of Evidence: 3.

Is serum gentamicin concentration modified with autologous cell-saved blood transfusion after total knee arthroplasty using tranexamic acid? A randomised control trial

BackgroundSelf-transfusion has been proven as an effective management of blood loss after total knee arthroplasty (TKA). Considering that the high local concentration of antibiotic from bone cement is delivered intravenously through the self-transfusion process, systematic toxicity has never been evaluated. In addition, the effectiveness of self-transfusion with the routine concomitant use of other modern blood-salvage strategies, like tranexamic acid, should also be assessed. Therefore, we performed a randomised study to assess: 1) the safety of self-transfusion in TKA by comparing the gentamicin concentrations resulting from the use or not of autologous blood transfusion; 2) the efficacy of self-transfusion in TKA, with the concomitant administration of tranexamic acid. HypothesisSelf-transfusion in TKA elevates the serum gentamicin concentration and the potential risk of nephrotoxicity. MethodsThe serum concentration of aminoglycosides was measured in two groups of 20 patients each, after TKA, according to the use of self-transfusion. Hemoglobin, renal function and calculated blood loss were compared at several points in time between groups. ResultsThe only time where there was a statistically significant difference in serum gentamicin, was at 48h postoperatively between groups [0.3 ug/mL±0.21, range: 0.15 to 0.72 vs. 0.14ug/mL±0.1, range: 0 to 0.35 (p=0.02)]. There were no significant differences in total blood loss [1341mL±501, range: 830 to 2230 vs. 1263mL±459 range: 840 to 2480 (p=0.67)] and need of allogeneic blood transfusion [3 units vs. 2 units] between groups. ConclusionThe use of autologous blood transfusion was found to be safe, in terms of nephrotoxicity of aminoglycosides after TKA, but it seemed to be ineffective as a blood salvage strategy, when used concomitantly with the administration of tranexamic acid. Level of evidenceII; low-powered randomised study. ClinicalTrials.gov registration numberNCT04505748.

The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery

Background ContextMetastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS. PurposeThis study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS. Study DesignThis is a retrospective controlled study. Patient SampleA total of 176 patients undergoing MSTS were included in the study. MethodsAll patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared. ResultsData included 63 cases (IOCS-LDF) and 113 controls (non–IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups. ConclusionsWe have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.

Evaluation of clinical, hematological, and biochemical changes following autologous blood transfusion in goats

Blood transfusion is an important remedy to manage animals with severe anemia. The risk of pathogen transmission can be reduced using autologous blood transfusion. Due to the lack of studies related to the use of autologous blood transfusions in goats, this study was conducted to evaluate the clinical, hematological, and biochemical changes following blood collection and reinfusion in goats. Fifteen milliliters per kilogram of whole blood was collected and reinfused after 7 days. The heart rate and respiratory rate were increased following blood collection and decreased to normal values within 48 and 6 h, respectively (p < 0.05). The hematocrit and red blood cells were increased significantly (p < 0.05) following blood reinfusion and decreased 48 h thereafter. White blood cells were increased 3 h after blood reinfusion and decreased within 96 h (p < 0.05). With respect to biochemical parameters, the total protein was increased significantly (p < 0.05) following blood reinfusion and decreased 96 h thereafter. Urea and creatinine were increased 3 h after blood collection and decreased within 24 h (p < 0.05). In conclusion, slight changes in clinical, hematological, and biochemical parameters indicated that the autologous blood transfusion technique proposed in this study was safe and could be used in clinical practices in goats.

Towards the identification of autologous blood transfusions through capillary electrophoresis

The use of autologous blood transfusions by endurance athletes has remained one of the most difficult doping practices to detect. The implementation of the Athlete's Biological Passport by some sporting bodies has proved to be effective; however, the analysis relies on the long-term monitoring of numerous biological markers, looking for abnormal variations in a number of biological markers to indicate doping. This work introduces an approach to identify autologous blood transfusions by examining the red blood cells (RBCs) directly. By using high-speed capillary electrophoretic separations, the relative distribution of the sizes of the RBCs in a sample can be established in under 3min, following the preparation of the cells. As RBCs that have been stored for transfusions undergo vesiculation, the relative size of the transfused cells differs from the native cells. The capillary electrophoretic separation allows for a rapid examination of this distribution and the changes that are seen when transfused RBCs are mixed with native cells. In this work, the effectiveness of this approach is demonstrated in the identification of simulated (in vitro) autologous blood transfusions performed with blood samples from three highly trained cyclists; it was possible to rapidly identify when as little as 5% of the RBCs in the sample were from a simulated autologous transfusion.

Transfusion drains versus suction drains in total knee replacement: meta-analysis

The use of autologous blood transfusion drains in orthopaedic surgery has been the subject of debate for several years. The aim of this meta-analysis was to review the use of autologous blood transfusion drains in total knee replacement. The primary outcomes were as follows: the number of patients requiring homologous blood transfusion, pre-operative haemoglobin and post-operative haemoglobin days 5-7. The secondary outcome measures for the meta-analysis were drainage volume, length of hospital stay, average number of units transfused per patient, post-operative wound infection, and deep vein thrombosis. Eight randomised controlled trials met the inclusion criteria and were included in this analysis. Autologous transfusion drains were associated with a decrease in the number of patients requiring post-operative blood transfusion (pooled odds ratio = 0.36, 95% CI = 0.15-0.85, P = 0.02), the number of units transfused per patient (weighted mean difference = -0.84 (95% CI = -1.13 to -0.56), P < 0.0001), and length of hospital stay (weighted mean difference = -0.25 (95% CI = -0.48 to -0.01), P = 0.04). The results of our study highlight both likely clinical and economic benefits within total knee replacement surgery. The clinical benefits of autologous transfusion drains in the total knee replacement surgery suggested by this meta-analysis include a reduced requirement for post-operative blood transfusion and a shorter length of hospital stay. However, further large-scale high-powered randomized controlled trials are recommended to further elucidate subtle effects of autologous drains on post-operative outcome following total knee replacement. II.

Perioperative Haemorrhage and Transfusion in Musculoskeletal Tumour Surgery.

Background and Objectives: Musculoskeletal tumor surgery in the West African subregion is rapidly evolving. These procedures are associated with significant blood losses necessitating large amount of transfusion, of which there is inadequate documentation. Allogeneic blood transfusion has been associated with increased recurrence of malignancies and is fraught with various complications. This study is aimed at evaluating the blood loss and transfusion requirements in various musculoskeletal tumor surgeries at a tropical Orthopedic Oncology unit. Method: A prospective study was conducted in patients with musculoskeletal tumors, undergoing surgery over a 5 year period. 74 procedures were performed in 58 patients and data such as age, sex, tumor type, surgical procedure, total blood loss, amount of blood transfused and attendant complications were retrieved. Results: The age range of the patients was 7 to 85 years with a mean age of 26.1 years. [M:F ratio 1.6: 1]. Surgery for benign bone tumors accounted for 55% of the procedures performed, while primary malignant lesions were the diagnosis in 41% of cases. Surgery was performed for secondary malignant tumor in 4% of cases. Tourniquet use was possible in only 36% of the surgeries, and the operation time range from 42 to 184 minutes [mean 67.5 minutes]. The range for total blood loss was 5 to 4950 mls. The mean blood loss was more for extensive procedures such as, forequarter amputations, above knee amputations, and resection / reconstruction. There was significant correlation between the total blood loss and the operation time. Blood transfusions were required in 57.1% of the surgeries and the total number of units transfused range from 0 to 4500 mls. The early complications of blood transfusion noted in these patients include, febrile reaction [33%], malaria fever [21%], hemolytic reaction [6%]. Conclusions: Blood loss in Orthopaedics musculoskeletal tumour surgery is significantly high, warranting large amount of blood transfusion. Adoption of standard blood management strategies by individual units, the use of autologous blood transfusion, and recombinant erythropoietin may reduce the attendant complications associated with blood transfusion. Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 63-65

Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients

Allogeneic blood transfusion-induced immunomodulation (TRIM) and its adverse effect on the prognosis of patients treated surgically for cancer remain complex and controversial. However, the potential risk associated with allogeneic blood transfusion has heightened interest in the use of autologous blood transfusion. In the present study, the serum concentrations of neopterin, interferon-gamma (IFN-gamma), T lymphocyte subsets (CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+)) and a possible association between these variables were investigated. The purpose was to further evaluate the effect of autologous versus allogeneic blood transfusion on immunological status in patients undergoing surgery for gastric cancer. Sixty ASA I-II (American Society of Anesthesiologists) patients undergoing elective radical resection for stomach cancer were randomly allocated to receive either allogeneic blood transfusion (n=30) or autologous blood transfusion (n=30). Serum concentrations of the neopterin, IFN-gamma and T lymphocyte subsets in the recipients were measured before induction of anesthesia, after operation, and on the 5th postoperative day. Both two groups, serum neopterin, IFN-gamma, percentages of T-cell subsets (CD3(+), CD4(+)), and CD4(+)/CD8(+) ratio had significantly decreased after operation, but decreased more significantly in group H (receiving allogeneic blood transfusion) than those in group A (receiving autologous whole blood transfusion) (P<0.05). On the 5th postoperative day, serum neopterin, IFN-gamma, CD3(+), CD4(+) T-cells, and CD4(+)/CD8(+) ratio returned to the baseline values in group A. In contrast, the above remain decreasing in group H, where there were no significant relations between serum neopterin and IFN-gamma. Perioperative surgical trauma and stress have an immunosuppressive impact on gastric cancer patients. Allogeneic blood transfusion exacerbates the impaired immune response. Autologous blood transfusion might be significantly beneficial for immune-compromised patients in the perioperative period, clearly showing its superiority over allogeneic blood transfusion.

Autologous blood transfusion

Autologous blood transfusion is the collection of blood from a single patient and retransfusion back to the same patient when required. This is in contrast to allogenic blood transfusion where blood from unrelated/ anonymous donors is transfused to the recipient. The primary driving forces for the use of autologous blood transfusion are to reduce the risk of transmission of infection

Effects of cell saver autologous blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing cardiac surgery on- versus off-cardiopulmonary bypass: a randomised trial☆

Off-pump CABG is potentially associated with reduced intraoperative blood loss and homologous blood transfusion in comparison to on-pump CABG. In this randomised controlled study we investigated the effects of autologous cell saver blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing CABG on- versus off-CPB. Eighty patients were randomised into one of four groups: (A) on-CPB with cell saver blood transfusion (CSBT), (B) on-CPB without CSBT, (C) off-pump with CSBT and (D) off-pump without CSBT. Volume of intraoperative autologous blood transfusion, postoperative mediastinal blood loss and homologous blood transfusion requirements were measured. Homologous blood was transfused when haemoglobin concentration fell below 8 g/dl postoperatively. Pre- and postoperatively prothrombin time and partial thromboplastin time were measured. Preoperative patient characteristics were well matched among the four groups. The amount of salvaged mediastinal blood available for autologous transfusion was significantly higher in the on-pump group (A) compared to the off-CPB group (C) (433+/-155 ml vs 271+/-144 ml, P=0.001). Volume of homologous blood transfusion was significantly higher in group B vs groups A, C and D (595+/-438 ml vs 179+/-214, 141+/-183 and 230+/-240 ml, respectively, P<0.005). The cell saver groups (A and C) received significantly less homologous blood than the groups without cell saver (160+/-197 ml vs 413+/-394 ml, respectively, P<0.005). Patients undergoing off-CPB surgery received significantly less homologous blood than those undergoing on-CPB CABG irrespective of cell saver blood transfusion (184+/-214 ml vs 382+/-397 ml, P<0.05). Postoperative blood loss was similar in the four groups (842+/-276, 1023+/-291, 869+/-286 and 903+/-315 ml in groups A to D, respectively, P>0.05). Clotting test results revealed no significant difference between the groups. There was no significant difference in postoperative morbidity between groups. Off-pump CABG is associated with significant reduction in intraoperative mediastinal blood loss and homologous transfusion requirements. Autologous transfusion of salvaged washed mediastinal blood reduced homologous transfusion significantly in the on-CPB group. Cell saver caused no significant adverse impact on coagulation parameters in on- or off-CPB CABG. Postoperative morbidity and blood loss were not affected by the use of CPB or autologous blood transfusion. We recommend the use of autologous blood transfusion in both on- and off-pump CABG surgery.

Indication and Efficacy of Autologous Blood Transfusion for Pregnant Women

Objective and methods:The usefulness of autologous blood transfusion was evaluated in 91 women undergoing autologous blood reservation based on the amount of blood loss during delivery, and the frequency and amount of reserved autologous blood transfused.Results:Although the mean frequency of homologous blood transfusion was 0.87% before the initiation of auto‐logous blood reservation, it decreased to 0.41% after the initiation of autologous blood reservation. Among 80 women (87.9%) who underwent autologous blood transfusion, homologous blood transfusion was further required in 5 women (5.5%) due to unexpectedly massive bleeding during delivery. All of these 5 women had a past history of cesarean section due to the presence of placenta previa. Of 24 women with placenta previa who underwent autologous blood reservation (excluding those with a past history of cesarean section), homologous blood transfusion might be required in 13 women (54.2%) due to more than 1500 ml of blood loss during cesarean section, but homologous blood transfusion was avoided in all of these 13 women. Even in women who did not require emergency intraoperative blood transfusion, anemic symptoms were improved by postoperative transfusion of reserved autologous blood without producing any adverse reactions.Conclusions:These findings suggest that autologous blood transfusion may decrease the frequency of homologous blood transfusion in women with a possibility of massive bleeding during cesarean section due to the presence of placenta previa, a past history of cesarean section, or uterine leiomyoma developing in the anterior wall. Therefore, further distribution of autologous blood transfusion is needed in the future.

Surgical program for craniosynostosis using three-dimensional solid model, combined with autologous blood transfusion in a Japanese craniofacial unit.

Since April 1997 at St. Mary's Craniofacial Unit, simulated surgery using a three-dimensional solid model made preoperatively was carried out, which enable sufficient autologous blood banking before the surgery. This study was conducted in eight patients presenting with plagiocephaly, brachycephaly, and oxycephaly consisting of simple craniosynostosis and syndromic craniosynostosis. Four cases (numbers 1-4) conducted with simulated surgery using three-dimensional solid models and fronto-orbital advancement with reshaping, as well as autologous blood transfusion were selected for the later-term group. For the first-term group, four cases (numbers 5-8) that were performed before the introduction of the abovementioned treatment were selected. The later-term group compared with the first-term group showed a decrease in operating time by an average of 1 hour, blood loss during surgery by 90 ml, and one fifth the amount of homologous blood transfusion. Also, 2 cases in the later-term group (cases 3 and 4) were able to avoid homologous blood transfusion, and they had autologous blood transfusion of 30 to 33 ml/kg. The surgical techniques will be improved with repeated cases of simulated surgery, aiming for the minimum invasive surgery. Also, the use of autologous blood transfusion is expected to increase as a less invasive surgery.

Transfusion medicine : support of patients undergoing cardiac surgery.

There is still no alternative that is as effective or as well tolerated as blood; nevertheless, the search for ways to conserve, and even eliminate blood transfusion, continues. Based on hemoglobin levels, practice guidelines for the use of perioperative transfusion of red blood cells in patients undergoing coronary artery bypass grafting have been formulated by the National Institutes of Health and the American Society of Anesthesiologists. However, it has been argued that more physiologic indicators of adequacy of oxygen delivery should be used to assess the need for blood transfusion. Methods used for conserving blood during surgery include autologous blood donation, acute normovolemic hemodilution and intra- and postoperative blood recovery and reinfusion. The guidelines for the use of autologous blood transfusion are controversial and it does not appear to be cost effective compared with allogeneic blood transfusion in patients undergoing cardiac surgery. Similarly, the cost effectiveness of intra- and postoperative blood recovery and reinfusion need further evaluation. Treatment with recombinant human erythropoietin (rhEPO) remains unapproved in the US for patients undergoing cardiac or vascular surgery, but it is a valuable adjunct in Jehovah's Witness patients, for whom blood is unacceptable. The characterization of darbepoetin alfa, a novel erythropoiesis stimulating protein with a 3-fold greater plasma elimination half-life compared with rhEPO, is an important advance in this field. Darbepoetin alfa appears to be effective in treating the anemia in patients with renal failure or cancer and trials in patients with surgical anemia are planned. Desmopressin has been used to effectively reduce intraoperative blood loss. Topical agents to prevent blood loss, such as fibrin glue and fibrin gel, and agents that alter platelet function, such as aspirin (acetylsalicylic acid) or dipyridamole, need further evaluation in patients undergoing cardiac surgery. Aprotinin has been shown to preserve hemostasis and reduce allogeneic blood exposure to a greater extent than the antifibrinolytic agents tranexamic acid and aminocaproic acid. Controlled clinical trials comparing the costs of these agents with clinical outcomes, along with tolerability profiles in patients at risk for substantial perioperative bleeding are needed.