Predictors of allogenic blood transfusion in elective cardiac surgery after preoperative autologous blood donation

Purpose  Preoperative autologous blood donation (PAD) is important for reducing exposure to allogenic blood in cardiac surgery. Unfortunately, even after PAD, allogenic blood transfusion is not always avoided. We investigated the predictors of blood component usage during elective cardiac surgery in patients prepared with PAD. Methods  Clinical data were collected for 143 consecutive patients (103 men and 40 women; mean age, 62 ± 9 years) who underwent elective cardiac surgery after PAD (959 ± 240 ml), often using iron supplement and recombinant human erythropoietin. Results  Allogenic blood transfusion was avoided during and after surgery in 107 patients (75%), whereas 36 patients required an allogenic transfusion (4.1 ± 3.8 U of packed red cells, 3.4 ± 4.1 U of fresh frozen plasma, and 5.8 ± 11.0 U of platelet concentrate). The independent factors for perioperative allogenic blood transfusion in these patients included the pre-donation hemoglobin value, the preoperative platelet count, and the lowest hemoglobin value during cardiopulmonary bypass. Conclusion  Even with PAD for elective cardiac surgery, patients whose pre-donation hemoglobin value and preoperative platelet count are low may require allogenic blood transfusion.     

Utilization of preoperative autologous blood donation in elective surgery

Background: The aim of the present paper was to review the pattern of collection and transfusion of autologous red cells for elective surgical procedures Methods: Data on requests for preoperative autologous donation of blood were obtained from the Australian Red Cross Blood Service, Victoria and the Royal Melbourne Hospital for the calendar year 1998. The following information was collected: patient age, sex, surgery type, number of autologous units requested and collected and, if relevant, reasons for not achieving the requested collection. Transfusion of autologous units and any additional homologous units was confirmed from records at the blood banks of the Royal Melbourne Hospital and Melbourne Pathology (the pathology provider performing cross‐matching for the majority of autologous units collected by Australian Red Cross Blood Service, Victoria). Results: Over 12 months, 2803 units of autologous blood were requested and 2282 units collected from 1301 patients. The most common reason for failure to collect the number of units requested was insufficient time between referral and surgery. Of the autologous units collected, 73% were transfused giving a collection to transfusion ratio of 1.4. Sixty‐eight per cent of patients received their autologous units only, 10% received both autologous and homologous units, while 22% were not transfused. For the majority of procedures, patients using preoperative autologous donation of blood had higher transfusion rates than those who did not use this. Conclusions: Ninety per cent of patients undergoing preoperative autologous donation of blood successfully avoided homologous blood exposure. However, preoperative autologous donation of blood is both wasteful and increases the incidence of transfusion in surgical procedures.     

Recombinant human erythropoietin in preoperative autologous blood donation did not influence the haemoglobin recovery after surgery

BACKGROUND: Recombinant human erythropoietin in combination with preoperative autologous blood donation is an established regime for avoiding allogenic blood transfusions. The aim of the study was to determine endogenous erythropoietin production and haemoglobin recovery after preoperative autologous blood donation and surgery, with or without recombinant human erythropoietin treatment. METHODS: Thirty-eight patients having total hip joint replacement surgery were randomised to receive either autologous blood transfusion (control group) or autologous transfusion plus preoperative recombinant human erythropoietin treatment (EPO group). Haemoglobin, haematocrit, erythropoietin and reticulocyte concentrations were repeatedly analysed, before, during, and after surgery. RESULTS: No significant differences were found between the groups regarding haemoglobin, haematocrit, and erythropoietin, but the reticulocyte count increased significantly more in the EPO group. There was no difference in the requirement for allogeneic blood transfusions between the groups. The baseline haemoglobin was >13 g dL-1 in all but four patients. CONCLUSIONS: In patients with normal preoperative haemoglobin levels, recombinant human erythropoietin treatment did not improve haemoglobin levels, or reduce the need for allogenic blood transfusion. There were no differences in serum erythropoietin concentrations between the groups. We question whether recombinant human erythropoietin treatment facilitates preoperative autologous blood donation in patients with normal haemoglobin levels.     

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

We assessed the feasibility and efficacy of subcutaneous erythropoietinalpha (EPO) therapy and preoperative autologous blood donation(ABD) in children undergoing open heart surgery. Thirty-ninechildren were treated consecutively with EPO (100 U kg^–1s.c. three times a week in the 3 weeks preceding the operationand i.v. on the day of surgery) and two ABDs were made (Group 1).As controls to compare transfusion requirements, 39 consecutiveage-matched patients who had undergone open heart surgery duringthe two preceding years were selected (Group 2). In a meantime of 20 (SD 5) days, 96% of scheduled ABDs were performedand only three mild vasovagal reactions were observed. The meanvolume of autologous red blood cells (RBC) collected was 6 (1) ml kg^–1and the mean volume of autologous RBC produced as a result ofEPO therapy before surgery was 7 (3) ml kg^–1,corresponding to a 28 (11)% increase in circulating RBC volume.The mean volume of autologous RBC collected was not differentfrom that produced [6 (1) vs 7 (3) ml kg^–1,P=0.4]. Allogenic blood was administered to three out of 39children in Group 1 (7.7%) and to 24 out of 39 (61.5%) in Group2. Treatment with subcutaneous EPO increases the amount of autologousblood that can be collected and minimizes allogenic blood exposurein children undergoing open heart surgery. Br J Anaesth 2001; 87: 429–34     

Efficacy of preoperative donation of autologous blood in patients undergoing radical retropubic prostatectomy

BACKGROUND: Radical retropubic prostatectomy (RRP) has resulted in substantial blood loss and the frequent need for homologous blood transfusion. In this study, the efficacy of autologous blood transfusion, from medical and financial perspectives, was evaluated in patients undergoing RRP. METHODS: Between 1994 and 2000, 80 patients with localized prostate cancer underwent RRP in our institute. Based on informed consent, preoperative donation of autologous blood (PDA) was performed in 65 out of 80 patienets. Four or six units were donated during the first 3 years; however, donation units were reduced to a maximum of 4 units since 1997 onwards. The discard rate of donated blood and frequency of homologous transfusion were examined. Changes of hematocrit (Ht) and hemoglobin (Hb) levels through donation and surgery and important factors that may affect postoperative levels of Ht and Hb were evaluated in 56 patients receiving 4-unit donations. RESULTS: Overall, 2 or 4 units of donated blood were discarded in four patients and homologous transfusion was required in two patients. In 56 patients receiving 4-unit donation, the mean Ht level at predonation was 43.3%. Following donation, this decreased to 35.7%. The administration of recombinant human erythropoietin (rHuEpo) relieved declining Ht levels following donation, but changes in Ht levels after surgery were minor. Important factors related to postoperative decline of Ht and Hb levels were operative time and blood loss. CONCLUSIONS: The program of 4-unit PDA can be performed safely without rHuEpo injection, and it is useful to reduce the risk of requiring homologous transfusion. However, more efficient programs to relieve patient burden and to reduce medical cost are needed.     

Perioperative hemodilutional autologous blood transfusion in burn surgery

It is important to avoid or minimise allogeneic blood transfusion, because of possible alloimmunisation or disease transmission. In burn cases these risks are high, and predonated autologous transfusion is not practical. Perioperative haemodilutional autologous blood transfusion is considered applicable in burn surgery. This study evaluates the effectiveness of the technique in the treatment of burns.     

贮存式自体成分输血对胃肠肿瘤患者围术期免疫功能的影响

目的观察贮存式自体成分输血与异体输血对胃肠恶性肿瘤患者围术期细胞免疫和体液免疫的影响。方法选择择期全麻下行胃肠肿瘤根治手术患者60例,男33例,女27例,年龄53~69岁,体重47~70 kg,ASAⅠ或Ⅱ级。术中出血200~400 ml,Hb70 g/L时启动输血,将患者随机分为两组,每组30例。贮存式自体成分输血组(P组):术中输血时采用贮存式自体成分输血;异体输血组(A组):输血时采用异体输血。测定入室时、术毕即刻、术后1、3、7 d外周血中T淋巴细胞亚群、NK细胞百分比和IL-2、IL-10、TNF-α、穿孔素(perforin,PF)浓度。结果与入室时比较,术毕即刻至术后7 d A组CD3~+、CD4~+、NK细胞百分比和CD4~+/CD8~+比值明显降低(P0.05);术后3、7 d A组CD3~+、CD4~+、NK细胞百分比和CD4~+/CD8~+比值明显低于P组(P0.05);术后1~7 d A组IL-2浓度明显低于,IL-10浓度明显高于P组(P0.05)。与入室时比较,术毕即刻至术后3 d A组Ig G、Ig A含量明显降低(P0.05);术毕即刻P组Ig G、Ig A含量明显降低(P0.05),术后1、3 d恢复至术前水平。结论围术期异体输血可降低肿瘤患者T细胞亚群和NK细胞百分比并延长其恢复时间,也可一过性降低血浆中免疫球蛋白Ig G、Ig A含量,从而影响患者的免疫功能,而贮存式自体成分输血对肿瘤患者术后免疫功能的影响轻微。     

贮存式自体输血对急性失血性休克兔骨髓造血细胞的影响

目的探讨贮存式自体输血(PABD)对急性失血性休克新西兰家兔骨髓造血细胞的影响。方法雄性新西兰家兔24只,体重1.9~2.4kg,采用随机数字表法分为四组:对照组(CON组)、异体输血组(ABT组)、自体采血组(ABS组)及贮存式自体输血组(PAT组),每组6只。ABS组和PAT组模拟休克前进行3次自体血采集贮存,每次间隔1周,至休克前72h完成。CON组和ABS组进行股动脉分离不模拟休克,ABT组和PAT组兔急性失血性休克模型建立后,ABT组输入ABS组贮存的血液进行复苏,PAT组输入术前贮存的自体血液进行复苏。在血液贮存前(T1)、血液贮存后(T2)、休克前(T3)、复苏后即刻(T4)及复苏后24h(T5)测定四组家兔外周血的Hb、网织红细胞(RET)比例,复苏后24h抽取兔骨髓测定有核细胞计数和骨髓细胞静止期/合成前期(G0/G1)、合成期(S)、合成后期/分裂期(G2/M)各期所占比例。结果 T2~T5时ABS组,T2、T3时PAT组,T4时ABT组Hb浓度明显低于CON组(P0.05)。T2~T5时ABS组和PAT组RET比例明显高于CON组和ABT组(P0.05)。T5时ABS组和PAT组骨髓有核细胞计数分别为[(6.30±1.75)×107/ml]、[(5.64±2.42)×107/ml],明显高于CON组的[(3.16±1.09)×107/ml]和ABT组的[(2.28±0.92)×107/ml](P0.05)。ABS组和PAT组骨髓细胞G0/G1期比例明显低于CON组和ABT组,S期比例明显高于CON组和ABT组,G2/M期比例明显高于ABT组(P0.05);ABT组骨髓细胞G0/G1期比例明显高于CON组,S期和G2/M期比例明显低于CON组(P0.05)。结论贮存式自体输血能够通过刺激骨髓造血细胞由静止期进入增殖分裂期,增加网织红细胞比例,促进术后血红蛋白的早期恢复。     

自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用

目的观察术前自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用。方法60例骨科择期手术患者（预计出血量〉1000ml,ASAⅠ～Ⅱ级）,随机分为3组,每组20例患者。Ⅰ组采用术前自体血小板分离联合术中自体血回输,Ⅱ组采用单纯术中自体血回输,Ⅲ组不进行任何血液保护措施。各组分别于麻醉前、血小板分离后10min、保存的血小板或自体血回输前10min、回输后10min、术后24h、术后48h检测相应时点的血红蛋白水平、凝血功能、血小板水平和聚集功能、术中术后出血量及异体输血情况。结果三组的一般资料、术中出血量、术中术后的血红蛋白水平比较未见明显差异。与Ⅰ组相比,Ⅱ、Ⅲ组术后24h和术后48h的血小板水平和聚集功能明显降低（P〈0．05）,术后出血量及异体输血率则明显增高（P〈0．01）。结论术前自体血小板分离联合术中自体血回输可明显改善骨科手术患者的凝血功能,并有效降低术后出血量和异体血的输注。     

贮存式自体全血与单纯红细胞输注对家兔骨髓造血干细胞功能的影响

目的 探讨贮存式自体全血和红细胞成分对骨髓造血干细胞衰老相关指标的影响.方法 健康雄性新西兰家兔30只,3～6月龄,体重2.5～3.0 kg.采用随机数表法将其分为五组:对照组(C组)、单纯手术组(S组)、手术采血组(ABS组)、贮存式自体全血输注组(PAB组)和贮存式自体红细胞输注组(PARB)组,每组6只.C组家兔...     

Blood transfusion risks and alternative strategies in pediatric patients

Although the safety of the blood supply has been greatly improved, there still remain both infectious and noninfectious risks to the patient. The incidence of noninfectious transfusion reactions is greater than that of infectious complications. Furthermore, the mortality associated with noninfectious risks is significantly higher. In fact, noninfectious risks account for 87-100% of fatal complications of transfusions. It is concerning to note that the majority of pediatric reports relate to human error such as overtransfusion and lack of knowledge of special requirements in the neonatal age group. The second most frequent category is acute transfusion reactions, majority of which are allergic in nature. It is estimated that the incidence of adverse outcome is 18:100,000 red blood cells issued for children aged less than 18 years and 37:100,000 for infants. The comparable adult incidence is 13:100,000. In order to decrease the risks associated with transfusion of blood products, various blood-conservation strategies can be utilized. Modalities such as acute normovolemic hemodilution, hypervolemic hemodilution, deliberate hypotension, antifibrinolytics, intraoperative blood salvage, and autologous blood donation are discussed and the pediatric literature is reviewed. A discussion of transfusion triggers, and algorithms as well as current research into alternatives to blood transfusions concludes this review.     

脊柱内固定术患者自体血液回收-回输后氧代谢的变化

目的评价自体血液回收-回输对脊柱内固定术患者氧代谢的影响。方法40例行脊柱内固定手术病人随机分为两组:自体血液回收-回输组(A组,n=20);等量异体血液输入组(B组,n=20)。分别在麻醉前、输入自体血或等量异体血后、术毕时及术后1d,采集血液动力学和血气分析数据,计算心脏指数(CI)、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2),并测定血液乳酸(LA)浓度。结果与麻醉前相比,两组输血后、术毕时DO2升高(P<0.05),其他指标各时点差异无统计学意义(P>0.05)。与B组比较,术毕时A组ERO2降低(P<0.05),在各时点DO2、VO2差异无统计学意义,LA差异也无统计学意义,且数值均在正常范围内。结论自体血液回收技术在一定的出血范围之内,可以满足脊柱内固定术患者机体氧代谢的需求。     

Leucocyte content in blood processed by autotransfusion devices during open-heart surgery

Autologous red blood cells processed by autotransfusion devices have become increasingly common in major surgery. The finished product, however, often contains varying amounts of leucocytes. We compared leucocyte and their differential counts of blood processed by three autotransfusion devices (Haemonetics Cell Saver IV, Dideco Stat and Dideco Stat-P) during open-heart operations on 25 patients. In addition, a zymosan-induced, luminol-enhanced chemiluminescence method was used to evaluate the activity of neutrophils in prepared autologous blood. High leucocyte counts (3.6–10.9 × 10⁹1^-1) were found in all saved red blood cell concentrates. The leucocyte counts of autologous blood produced by the Haemonetics device were lowest ( P <0.01) and about one third of the patients' haematocrit-corrected counts. The proportions of neutrophils were higher in salvaged blood than in the blood circulation before anaesthesia or before retransfusion ( P <0.01). However, no general activation of neutrophils was seen, but the increase in chemiluminescence activity of about 30% that was seen in four patients may suggest an increased risk of reperfusion injury in such patients after aortic declamping. In conclusion, all three autotransfusion devices left leucocytes in the processed red blood cell concentrates, although great differences occurred between the devices.     

类风湿关节炎手术后自体引流血回输技术的应用

目的评价类风湿性关节炎(RA)患者手术后自体引流血回输的作用和使用安全性。方法93例RA患者随机分为两组。实验组(53例)术后使用自体引流血回输装置,对照组(40例)使用负压吸引瓶。记录引流量、回输血量及输血不良反应。结果实验组平均回输引流血759ml,其中6例平均输入库血165ml;对照组平均术后输库血824ml。两组患者手术前后的血红蛋白差异无显著性。两组中接受异体输血的患者有7例出现输血不良反应:荨麻疹4例(实验组2例,对照组2例),寒战、高热反应3例(均为对照组)。结论自体引流血回输是RA患者术后安全有效的输血方法。在术前没有自体血储备的情况下,该技术减少了输注库血的机会,避免血液传播疾病的发生。     

Intraoperative autologous blood transfusion for hemoperitoneum resulting from ectopic pregnancy or ovarian bleeding during laparoscopic surgery.

OBJECTIVE: Our purpose was to evaluate the efficacy and safety of intraoperative autologous blood transfusion during laparoscopic surgery for hemoperitoneum in benign gynecologic disease. METHODS: The Cell Saver, Haemo Lite 2, an intraoperative autologous blood salvage device, was used in laparoscopic surgery on 18 patients with ectopic pregnancies or ovarian bleeding who had a large hemoperitoneum with/without severe anemia and hypovolemic shock. RESULTS: The blood loss was 1186 +/- 789 mL, and the volume of reinfused processed blood was 661 +/- 405 mL in ectopic pregnancy cases. The blood loss was 716 +/- 219 mL, and the volume of reinfused processed blood was 496 +/- 138 mL in ovarian bleeding. Laparoscopic surgery was performed and homologous blood transfusion was not required in any patient. No adverse reactions or procedural difficulties associated with the autologous blood transfusions occurred. CONCLUSIONS: Intraoperative autologous blood transfusion enabled the performance of laparoscopic surgery for large hemoperitoneum caused by ectopic pregnancies or ovarian bleeding without a homologous blood transfusion.     

A randomized, parallel-group, open-label trial of recombinant human erythropoietin vs preoperative autologous donation in primary total joint arthroplasty: effect on postoperative vigor and handgrip strength

This randomized trial assessed the effect of recombinant human erythropoietin (EPO) vs preoperative autologous donation (PAD) on postoperative vigor and handgrip strength in patients undergoing primary total joint arthroplasty. Adults with baseline hemoglobin level of 11 to 14 g/dL received EPO (600 IU/kg once weekly for 4 doses, n = 130) or PAD (n = 121) before primary, unilateral hip or knee arthroplasty. Mean changes in vigor score and handgrip strength from baseline were not significantly different between treatment groups. Multivariate analyses found a significant treatment effect favoring EPO over PAD for vigor, but not for handgrip strength. Patients in the EPO group had higher hemoglobin levels and required fewer transfusions. Both treatments were well tolerated. Additional study is needed to elucidate the influence of blood management strategies on postoperative vigor.     

Benefits and risks of red blood cell transfusion in pediatric patients undergoing cardiac surgery

As the number of neonates and young infants undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) increases, red blood cell (RBC) transfusion will continue to be an integral part of the practice of pediatric cardiac anesthesiology. The decision of when to transfuse RBCs to these patients is complex and influenced by multiple factors such as size, presence of cyanotic heart disease, complexity of the surgical procedure, and the hemostatic alterations induced by CPB. The known benefits of RBC transfusion include an increase in the oxygen-carrying capacity of blood, improved tissue oxygenation, and improved hemostasis. Unfortunately, there is no minimum hemoglobin level that serves as a transfusion trigger for all pediatric patients undergoing cardiac surgery. Physiologic signs such as tachycardia, hypotension, low mixed venous oxygen saturation and increased oxygen extraction ratios can provide objective evidence of the need to augment a given hemoglobin level. Nevertheless, the benefits of RBC transfusion must be balanced against its risks and, in recent years, RBC transfusion has been subjected to intense scrutiny. The adverse consequences of RBC transfusion include the transmission of infectious diseases and immune-mediated and nonimmune-mediated complications. Advances in donor selection, infectious disease testing of donated blood, use of leukocyte reduction and irradiation of blood in defined situations have improved the safety of the blood supply in terms of infection transmission. However, a growing number of prospective randomized clinical trials are finding an association between RBC transfusion and an increased risk of morbidity and mortality even with the use of leuko-reduced blood. Thus, it is becoming increasingly important that the decision to transfuse RBCs be made with a thorough understanding of the benefit-to-risk ratio. This review addresses the benefits and risks of RBC transfusion, pertinent data acquired in the setting of congenital cardiac surgery and techniques designed to minimize the need for RBC transfusion.     

Preoperative autologous blood donation in primary total knee arthroplasty: critical review of current indications

Preoperative autologous blood donation (PABD) is a well established transfusion practice in elective orthopaedic surgery, involving immunologic and infective advantages but also involving exposure to not negligible risks, and costs as well. The aim of this study was to assess the real need for blood transfusions in primary total knee arthroplasty (TKA). Between January 2000 and July 2005, 214 patients underwent primary unilateral TKA. Altogether, 416 autologous blood units were collected, however only 47 (11.3%) were transfused. Thirty-eight patients (17.8%) received autologous blood, while 4 of them (10.5%) also received allogeneic blood. Based on the results of this study, PABD should be recommended in well selected patients undergoing TKA: older female patients with a low basal haemoglobin level.