Efficacy of preoperative donation of blood for autologous use in radical prostatectomy

To determine the amount of blood lost, the number of transfusions, and the effectiveness of preoperative autologous blood donation in radical prostatectomy, 163 patients' records from 1987 to 1991 were reviewed at four university hospitals and three community hospitals. Calculated red cell volume lost was 1003 +/− 535 mL (mean +/− SD), which corresponds to 44 +/− 18 percent (mean +/− SD) of total red cell volume. Preoperative donation of blood for autologous use reduced the rate of transfusion of allogeneic blood from 66 to 20 percent (p < 0.001). Of the patients who donated 1 to 2 units, 32 percent received allogeneic blood; 14 percent of those who donated 3 units received allogeneic blood. Donation of 4 units reduced the allogeneic transfusion rate to 11 percent. However, as the number of units donated increased (1-3 units), the units not transfused also increased (0-21%). Ninety-one (56%) of 163 patients donated fewer than 3 units. Autologous blood donation is effective in minimizing the transfusion of allogeneic blood to radical prostatectomy patients, but many patients do not donate enough blood (< 3 units). The donation of 3 units of blood for autologous use is recommended for patients who undergo radical prostatectomy.     

A provincial program of blood conservation: The Ontario Transfusion Coordinators (ONTraC).

PURPOSE: Although often life-saving, blood transfusions are associated with significant risk to the patient and escalating costs to the blood system and hospital. Transfusions are often given unnecessarily. Blood conservation represents the use of alternatives to transfusion. The ONTraC program attempts to enhance transfusion practice outside the blood transfusion laboratory, promote blood conservation in surgery patients, and reduce allogeneic red cell use. METHODS: In the first such large scale program, funding was obtained from the Ontario MOHLTC for a Transfusion Coordinator in 23 Ontario hospitals selected based on blood utilization and geography. At specific time periods, detailed anonymized information was collected in a defined number of all consecutive patients admitted for the three designated surgical procedures: knee arthroplasty (N=approximately 1200 at each time point), abdominal aortic aneurysm (AAA; N=300 at each time) and coronary artery bypass graft (CABG) surgery (N=300 at each time point). RESULTS: Considerable inter-institutional variation was observed in the proportion of patients and amount of blood transfused. At the 12 month analysis, most, although not all, hospitals had decreased use of allogeneic blood and there was an overall 24% reduction in blood use in patients undergoing knee surgery, 14% in AAA and 23% in CABG. In addition to reduction in proportion of patients transfused, transfused patients received fewer units of allogeneic blood. Patients who did not receive allogeneic transfusions had significantly lower postoperative infection rates (p<0.05) and length of stay (p<0.0001); multivariate analysis showed that allogeneic transfusion was an independent predictor of increased length of stay. Eighteen-month analysis indicates even greater reduction in allogeneic transfusion. The main measures of blood conservation employed were preoperative autologous donation and education, with recent increasing use of erythropoietin and the cell saver. These measures have been demonstrated to be very effective in avoiding allogeneic transfusion. CONCLUSIONS: The ONTraC have become leaders locally, nationally and internationally in blood conservation. The reduction in allogeneic transfusion associated with the implementation of the ONTraC program represents important savings in costs associated with blood components, hospital stay and work in transfusion laboratories and nursing units, as well as enhancing patient satisfaction and safety.     

Use of autologous blood in support of orthopaedic surgery using a hospital-based autologous donor programme

SUMMARY. The use of autologous blood in support of orthopaedic surgery has been assessed for 296 patients; 150 underwent hip arthroplasty, 69 underwent knee arthroplasty, 37 underwent spinal procedures and 40 underwent miscellaneous operations. Overall, 87% of patients received no allogeneic blood and 23% of the autologous blood collected was not used. For hip and knee arthroplasty, there appears to be an increased willingness to transfuse patients when autologous blood is available, and a decreased proportion of patients receiving more than 3 units for hip arthroplasty and 2 units for knee surgery, when compared with an audit of blood use
when almost all blood used was allogeneic. Wastage of autologous blood in support of spinal surgery was 66%, prompting a review of ordering practices. Assessment of avoidance of allogeneic transfusion by the standard schedule of 3 units for hip arthroplasty and 2 units for knee arthroplasty appears justified by the calculation that collection of an additional unit in each case would avoid allogeneic transfusion in 11 (5%) more patients with the unnecessary collection of 208 units.     

Causes of failure of a barcode-based pretransfusion check at the bedside: experience in a university hospital

summary .  The objective of this study was to assess the cause of failure of bedside barcode identification before blood administration. The bedside check is the most critical step for prevention of mistransfusion. A barcode patient-blood unit identification system was implemented in all inpatient wards, operating rooms and an outpatient haematology unit in July 2002. The transfusion service monitored compliance with bedside barcode identification and checked it at 24 h or 1 h after issuing of blood. If electronic checking was not completed at that time, the transfusion service clarified the cause of failure and indicated the immediate use of the issued blood when it was not yet transfused. From April 2004 to December 2007, a total of 43 068 blood components were transfused without a single mistransfusion and 958 transfusions (2·2%) were performed without electronic checking. The overall compliance rate with bedside barcode identification was 97·8%, and it was 99·5% in the past 6 months. The cause of failure of bedside barcode identification was human error in 811 cases (84·7%), handheld device error in 74 (7·7%), system error in 50 (5·2%) and wristband error in 23 (2·4%). The number of errors leading to failure of bedside barcode identification was decreased for human errors, especially manipulation errors, after initiation of notification at 1 h after issuing of blood. The transfusion service may have an important role in increasing transfusion safety by monitoring compliance with bedside verification and bedside use of issued blood.     

A survey of autologous blood collection and transfusion in Japan in 1997

BACKGROUND: In spite of the fact that autologous blood is safest for a patient to receive, it is not generally appreciated that adverse reactions during donation and transfusion may occur. This study was conducted to assess the state and the risk of autologous blood transfusion in Japan in 1997. STUDY DESIGN AND METHODS: Results of a nation-wide questionnaire-based survey are presented. The questionnaire assessed the number of autologous blood donations, donation procedures, and the adverse reactions associated with donation, preservation, recombination erythropoietin administration and transfusion. RESULTS: Between November 1996 and October 1997, 10,697,000 ml (or 53,485 units, 200 ml = 1 unit) prestorage blood donation were made by 14,200 patients (averages; 1.9 donations/patient, 753 ml/patient, 398 ml/donation). Of these, 87% were transfused to the patients and the remainder were discarded. Using hemodilution and blood salvage intra- or postoperatively some 2,540,000 ml of blood was collected and > 70% of patient-donors received such blood. Adverse reactions were observed with 1.6% (428/26,905) of donations including 6 angina and 2 asthma attacks. There were 63 (0.2%) problems with 28,705 donations and 117 (0.5%) errors/problems reported for 24,929 units transfused; the most frequent problems were clotting on the units and breakage of the bags during storage. Hypotension using hemodilution (3.7%), coagulation (0.9%) or bacterial contamination (0.4%) using salvage were often observed. A 10-20 ml volume of autologous fresh-frozen plasma was transfused to the wrong recipient. CONCLUSION: Autologous blood transfusion accounts for at least 1.1% (2.8% estimated) of the red cell supply in Japan. Errors and adverse reactions are not infrequent in autologous blood programmes. By introducing systematic safety policies, we will be able to make autologous blood transfusion safer.     

输血支持在造血干细胞移植中的应用

背景:接受造血干细胞移植的患者经常需要血液制品输注支持,而患者对红细胞和血小板输注的需求差异非常大,这主要依赖于造血干细胞移植的类型和患者本身的疾病性质。目的:评价中山大学附属中山医院接受造血干细胞移植患者移植期间输血的需求和数量。方法:收集中山大学附属中山医院2004-01/2010-06接受造血干细胞移植患者的资料,包括移植的适应证、移植的类型、CD34+细胞的数量、红细胞和血小板的输注数量、费用、脱离输注时间以及中性粒细胞和血小板植入时间;红细胞输注的阈值是血红蛋白计数为70g/L,而血小板的输注阈值是计数为20×109L-1。研究分析了患者移植期间红细胞和血小板输注的需求、输注量、输血费用,以及患者的生存情况。结果与结论:自体造血干细胞移植组中有14例(93%)患者,而异基因造血干细胞移植组中有35例(90%)患者显示了造血细胞植入和脱离输注证据。自体造血干细胞移植组取得脱离红细胞输注天数为14.6d,明显短于异基因造血干细胞移植组。与异基因造血干细胞移植组比较,自体造血干细胞移植组红细胞输注单位明显减少;而异基因造血干细胞移植组的红细胞输注费用明显高于自体造血干细胞移植组。输血花费昂贵,但却是造血干细胞移植中必不可少的一部分,异基因造血干细胞移植组需要更多的输血支持。脱离输注时间有望成为评估造血干细胞移植成功的指标。     

A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery

Allogeneic blood transfusion has been implicated as an independent risk factor for postoperative bacterial infection in clinical and animal studies. The association among transfusion, quantitative immunologic factors, and infection was examined in 102 patients undergoing 109 spinal fusion procedures. In 60 procedures, patients received autologous blood only; in 24 procedures, they received at least 1 unit of allogeneic blood, and in 25 procedures, they received no transfusions. Twenty-two patients developed bacterial infections, in 8 cases while in hospital and in 14 cases after discharge. Univariate analysis revealed that patients who received any allogeneic blood and those who received no allogeneic blood differed significantly in the rate of hospital-acquired infection (20.8 vs. 3.5%), length of stay (12.3 vs. 9.7 days), days of fever greater than or equal to 38 degrees C (4.0 vs. 2.9), days on antibiotics (3.9 vs. 2.5), duration of surgery (309 vs. 231 min), blood loss (1343 vs. 887 mL), surgeon, and postoperative drop in natural killer (NK) cells (-174 vs. -42/microL). Multivariate logistic and linear regressions revealed that the number of allogeneic units transfused was the only significant predictor of in-hospital infection (p = 0.016) or days on antibiotics and length of stay. None of the clinical, surgical, or transfusion variables was significantly associated with posthospital infection, although a significantly greater drop in NK cells had occurred in patients who developed infection (p = 0.0035). These data strongly implicate allogeneic transfusion as a risk factor for in-hospital postoperative bacterial infection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Autologous donation error rates in Canada

BACKGROUND: Although certain transfusion risks are eliminated by the use of autologous blood, clerical errors may still occur. In addition, because of differences in donor selection criteria and donor-patient expectations, the consequences of certain errors may be different in autologous and allogeneic donations. STUDY DESIGN AND METHODS: In January 1996, autologous donation error rates in Canada from 1989 to November 1995 were estimated by 1) a detailed questionnaire sent to hospitals supplied by the Canadian Red Cross, Blood Services, Transfusion Center of Quebec at Montreal autologous donation program (n = 31), 2) a review of that institution's quality assurance non- compliance reports, and 3) a detailed questionnaire sent to other Canadian Red Cross centers with autologous donation programs (n = 16) and hospital-based autologous programs in Canada (n = 3). The total number of autologous donations collected was determined from Canadian Red Cross annual reports and information supplied by hospital-based programs. RESULTS: There were 113 errors reported for 16,873 units collected by the Montreal center (1/149 units) based on collection center and hospital data. The most frequent errors were the late receipt of units for surgery (25% of errors) or the receipt of units in the wrong hospital (23%). Other Canadian programs reported 166 errors for approximately 53,500 units collected (1/322 units). However, this figure was based mainly on collection center, and not hospital, data. The most frequent errors were in labeling (48%) and component preparation (25%). One unit of autologous fresh-frozen plasma was transfused to the wrong recipient. Errors were more frequent if components were produced, if units were drawn in hospitals for interhospital transfer, or it units were shipped between Red Cross centers. CONCLUSION: Errors are not infrequent in autologous donation programs. Autologous transfusion should not be considered as being without risk.     

P07Reduction of Allogeneic Red Cell Transfusion using Autologous Blood Cell Salvage in Knee Arthroplasty

Recent Hospital Transfusion Committee (HTC) audit at the Royal Bournemouth Hospital (RBH) confirmed an allogeneic red cell transfusion rate of 20% for primary Total Knee Replacement (TKR). Current policy at RBH states that when blood stocks reach 67% of normal (amber alert) then surgery with a >20% likelihood of blood transfusion will be cancelled. At current transfusion rates this would include primary TKR. Recent studies have shown a reduction in allogeneic transfusion rates when autologous transfusion drains are utilized. The purpose of this study was to see whether the current rate of allogeneic transfusion could be reduced with the introduction of the CellTransTM Autologous Knee Drainage Blood Transfusion System (ABT) in TKR at RBH. Over a 3 month period all patients undergoing primary, bilateral or revision knee arthroplasty received an ABT. Demographic data was collected from the orthopaedic pre‐assessment clinic. Following surgery further data was collected relating to volume of blood loss into the drain, volume of autologous blood re‐transfused, units of allogeneic blood required and the transfusion trigger, postoperative haemoglobin levels, infection rates and length of stay in hospital. We then compared this data set with retrospective data. Of 170 patients undergoing knee arthroplasty 141 received the ABT. The data collected was compared retrospectively with 169 patients from the previous 3 month period. We demonstrated a reduction in transfusion rates of 13% for primary TKR, 42% for bilateral TKR and 57% for revision TKR with the use of the ABT. In addition we demonstrated a reduction in total allogeneic blood use (99 units to 26 units) and a reduction in mean length of stay in hospital (8.6 days to 7.5 days) with the ABT. Further analysis of the data collected showed a 46% reduction in the allogeneic transfusion rate and a reduction in total allogeneic blood usage (99 units to 9 units) of anaemic patients presenting for surgery. This study has demonstrated a dramatic reduction in allogeneic blood transfusion rates with the use of the CellTransTM Autologous Blood Transfusion System. We have also shown a reduction in length of stay in hospital. Prior to the study primary total knee replacement would have been cancelled during times of limited blood availability (amber alert). The use of the ABT is good for the patient in reducing the need for allogeneic blood, and in addition has demonstrated a significant cost saving due to the reduced blood usage and potential prevention of cancelled operation lists.     

Blood transfusion in a random sample of hospitals in France

BACKGROUND: Representative information on blood use is scarce. A large-scale study of blood recipients and blood use in France was conducted. STUDY DESIGN AND METHODS: Based on a random sampling, this study was carried out in teaching and other hospitals between March and December 1997. In each hospital, a patient was included if he or she received an allogeneic or an autologous transfusion during the observation period for that hospital. For each recipient, product and patient characteristics for 24 hours after inclusion were collected. RESULTS: From the 175 hospitals that had given a transfusion to at least one patient during the observation period, 3206 patients were included. Most transfusion recipients (57%) were over 65 years old; 42 percent were in teaching hospitals and 53 percent in medical wards. Among the 3044 adults, 91 percent received an allogeneic transfusion. Fifty-three percent of allogeneic units were WBC reduced. The indications most frequently reported for allogeneic transfusion were neoplasms (48%) and those for autologous transfusion were disorders of musculoskeletal (63%) or circulatory (15%) systems. The patients in nonteaching hospitals were more often transfused during surgery and were more likely to be aged and to have a musculoskeletal disorder than were patients in teaching hospitals. CONCLUSION: General collection of such data, within a system of traceability, could provide relevant denominators from which to interpret adverse-reaction data.     

Utility of red blood cell apheresis in autologous blood donation

Although autologous blood donation is an alternative to allogeneic transfusion, some authors had questioned its cost-effectiveness. New techniques, like red blood cell apheresis could improve the cost-effectiveness of autologous blood transfusion, therefore we have valued the efficiency of this procedure in autologous blood donation. MATERIALS AND METHODS: We studied 131 patients undergoing different types of surgery who entered the preoperative autologous blood donation program over a one year period. Apheresis was performed with the MCS 3p from Haemeonetics. RESULTS: We were able to collect 304 red blood cell units from 131 patients. The average yield per procedure was two units (88 cases, 67.2%). In 41 patients (31.3%), we collected 3 units and, in two cases, 4 units were collected. The mean volume of the units was 255 (191-280). 18 (13.7% patients had an adverse reaction. Most of these were mild. Only in one case was it necessary to stop the procedure. 202 units (66.4%) were transfused to 97 patients (74%). 12 (9.2%) patients also used allogeneic transfusions (mean units: 0.18+/-0.05 with a range 1-5). CONCLUSION: Red blood cell apheresis is a useful procedure in autologous blood donation.     

Autologous blood donation and subsequent blood use in patients undergoing total knee arthroplasty

Autologous blood donation is designed to avoid complications from allogeneic blood, leaving units of blood in the general blood supply. It is unclear how efficient these programmes are in accomplishing these goals. It is unclear if autologous donation provokes increased need for any transfusion following surgery and whether it can be avoided in low-risk surgeries. Of 430 patients undergoing unilateral primary knee replacement arthroplasty over 12 months in our hospital, 309 had autologous donations and 121 did not. Of the 121 patients who did not donate, 36% completed surgery without transfusion, whereas only 17% of those who had autologous donations did so (P < 0.05). Age less than 65 years, higher baseline and postoperative haemoglobin levels were associated with lower transfusion rates. Patients who had autologous donations were approximately four times more likely to be transfused. As the number of autologous units donated increased, transfusions following surgery increased. Autologous donation did reduce allogeneic blood transfusions. Therefore, autologous blood donation for unilateral total knee arthroplasty is associated with overall increased transfusion rates, but with reduced need for allogeneic blood, independent of other clinical factors associated with transfusion. Therefore, there is need for reconsideration of these programmes relative to specific surgeries.     

Collection and transfusion of blood and blood components in the United States, 1992

BACKGROUND: Studies were conducted to measure the state of the United States' national blood resource in 1992 and changes therein from 1989. STUDY DESIGN AND METHODS: With data supplied by the American Red Cross and the American Association of Blood Banks, as well as data from a stratified random-sample survey of 3350 non-American Association of Blood Banks hospitals, statistical methods were applied to estimate national blood activities in 1992. RESULTS: The total US blood supply in 1992 was 13,794,000 units, a decrease of 3.1 percent from 1989. Some 11,307,000 red cell units were transfused to 3,772,000 patients, an average of 3.0 units per transfused patient. Preoperative autologous blood deposits totaled 1,117,000 units, a 70-percent increase over 1989. Of this number, 566,000 units (50.7%) were transfused, 5,000 (4.4%) transferred to the allogeneic supply, and 546,000 (48.9%) discarded. Of 436,000 directed-donation units, 136,000 (31.2%) were transfused, 57,000 (13.1%) transferred to allogeneic supply, and 243,000 (55.7%) discarded. The total allogeneic blood supply, including imports, decreased by 7.4 percent from 1989, and allogeneic blood transfusions, including those to children, decreased by 8.6 percent. Over 8,300,000 platelet units were transfused; of these, some 3,600,000 were apheresis platelets. In addition, 2,255,000 units of plasma and 939,000 units of cryoprecipitate were transfused. CONCLUSION: While the US blood supply was adequate for transfusion needs in 1992, blood collections and red cell transfusions had decreased substantially since 1989.     

Changing indications for red cell transfusion from 2000 to 2004 in the North of England

Falling donor numbers and the threat of transfusion-transmitted variant Creutzfeldt-Jakob disease may lead to shortages in the national blood supply. Knowledge of current patterns of transfusion and trends in usage will help predict future change in blood use. Our previous survey identified medical indications as the major reason for transfusion, but detailed information within this category was limited. We performed prospective surveys of indications for red cell transfusion for two 14-day periods in 2004 in the North of England, concentrating on medical reasons for transfusion. Data were obtained for transfusion indications of 9003 units, which accounted for over 99% of red cell issues from the regional blood centre during the study. In 2004, medical patients received 62% (5558 units) of all transfused units, surgical patients 33% (3001 units) and Obstetric & Gynaecology patients 5% (444 units). These figures compare with 52, 41 and 6% for Medicine, Surgery, and Obstetrics & Gynaecology in 1999/2000. The three largest uses of blood within the medical category were for patients with primary haematological disorders (18.2% of all transfused blood), for management of gastrointestinal haemorrhage (13.8%) and for patients with nonhaematological malignancies (8.8%). There has been a significant reduction in use of blood for surgical indications over the last 5 years, but an absolute increase in use of blood for medical indications. Lower transfusion triggers, education, use of cell salvage, the increasing price of a unit of red cells and changing population demographics may all have contributed to the reduction in surgical blood use. Promotion of good transfusion practice and alternatives to allogeneic transfusion should now focus on medical and surgical use of blood transfusion.     

输血支持在造血干细胞移植中的应用

背景：接受造血干细胞移植的患者经常需要血液制品输注支持,而患者对红细胞和血小板输注的需求差异非常大,这主要依赖于造血干细胞移植的类型和患者本身的疾病性质。目的：评价中山大学附属中山医院接受造血干细胞移植患者移植期间输血的需求和数量。方法：收集中山大学附属中山医院2004-01/2010-06接受造血干细胞移植患者的资料,包括移植的适应证、移植的类型、CD34＋细胞的数量、红细胞和血小板的输注数量、费用、脱离输注时间以及中性粒细胞和血小板植入时间;红细胞输注的阈值是血红蛋白计数为70g/L,而血小板的输注阈值是计数为20×109L-1。研究分析了患者移植期间红细胞和血小板输注的需求、输注量、输血费用,以及患者的生存情况。结果与结论：自体造血干细胞移植组中有14例（93%）患者,而异基因造血干细胞移植组中有35例（90%）患者显示了造血细胞植入和脱离输注证据。自体造血干细胞移植组取得脱离红细胞输注天数为14.6d,明显短于异基因造血干细胞移植组。与异基因造血干细胞移植组比较,自体造血干细胞移植组红细胞输注单位明显减少;而异基因造血干细胞移植组的红细胞输注费用明显高于自体造血干细胞移植组。输血花费昂贵,但却是造血干细胞移植中必不可少的一部分,异基因造血干细胞移植组需要更多的输血支持。脱离输注时间有望成为评估造血干细胞移植成功的指标。     

Simplified enrollment for autologous transfusion: automatic referral of presurgical patients for assessment for autologous blood collections.

We implemented a pilot program at our institution for automatic referral of patients for presurgical assessment for preoperative and intraoperative collection of autologous blood. Although patients and clinicians support the use of autologous transfusion, often a request for collection of autologous blood is not initiated. During 11 months, 269 patients (82%) of three orthopedic surgeons entered the program, and 218 underwent operation and were dismissed from the hospital. A total of 940 units of autologous blood (675 preoperatively and 265 intraoperatively) was collected from these 218 patients, and 84% of the units were transfused. Throughout hospitalization, 86% of the patients received only autologous blood, whereas 14% received various proportions of homologous and autologous blood. In contrast, only 26% of a concomitant control group of 220 consecutive orthopedic surgical patients not participating in the automatic-referral program received only autologous blood. Thus, the automatic-referral program increased the percentage of elective orthopedic surgical patients who received only autologous blood from 26% to 86% (P less than 0.001). This study also showed that the same amount of blood was used for autologous transfusions as was routinely used for homologous transfusions in similar cases. The automatic-referral system was convenient for physicians and patients and offered the benefits of reduction of transfusion-associated risks and amelioration of patient anxieties.     

Mathematical analysis of isovolemic hemodilution indicates that it can decrease the need for allogeneic blood transfusion

BACKGROUND: The implementation of acute isovolemic hemodilution prior to surgical blood loss is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential, attendant complications. Studies examining the efficacy of this technique have produced conflicting results. STUDY DESIGN AND METHODS: The present mathematical analysis was undertaken to resolve these conflicts by determining the efficacy of hemodilution and examining the influence of the variables affecting the outcome. Efficacy was defined as the volume of additional blood loss permitted and the volume and number of units of allogeneic blood saved from transfusion. A mathematical analysis evaluated the impact of circulating blood volume and initial and target hematocrits on the efficacy of isovolemic hemodilution. It was assumed that 1) hemodilution was completed before surgical blood loss; 2) transfusion of removed blood was begun when the target hematocrit was reached and lost surgical blood was replaced at a rate that maintained the target hematocrit; 3) allogeneic transfusion was begun after all autologous blood drawn was transfused; 4) normovolemia was maintained; and 5) a unit of allogeneic blood contains 175 mL of red cells. RESULTS: The analysis showed that isovolemic hemodilution can result in substantial additional allowable surgical blood loss that can diminish the need for or obviate allogeneic transfusion of red cells. Larger circulating blood volume, higher initial hematocrits, and lower target hematocrits increase the efficacy of hemodilution. Removal and isovolemic replacement of 1 to 2 units of blood provide minimal potential savings, as does hemodilution to a circulating (target) hematocrit of 30 percent. The extension of hemodilution to a hematocrit of (or below) 20 percent allows a disproportionately greater surgical blood loss and diminishes the need for allogeneic transfusion. It allows, for example, an additional 4.5 L of surgical blood loss, which represents a savings of 4 units of allogeneic blood when a patient with an initial blood volume of 5.0 L and a hematocrit of 45 percent undergoes isovolemic hemodilution to a hematocrit of 15 percent. CONCLUSION: Isovolemic hemodilution can diminish or in some circumstances eliminate the need for allogeneic transfusion.     

Preoperative autologous blood deposition in support of gynaecological repair procedures

Autologous blood transfusion was evaluated in gynaecological repair procedures including abdominal/vaginal hysterectomy with vaginal repair, post-hysterectomy vaginal suspension and fixation, uni/bilateral salpingo-oophorectomy with vaginal colpopexy and sling procedures. A total of 247 autologous units were collected from 95 patients at the regional blood centre with 1–3 units (mean 2.6 units) deposition from each patient. One hundred and ninety of all collected units were transfused (collection/transfusion ratio = 1.3). Of these patients, 86 (90.5%) received autologous blood; 12 (13%) being transfused with 1 unit, 44 (46%) with 2 units and 30 (32%) with 3 units. Two of these patients received additional homologous blood. The average preoperative haemoglobin level was 119 g L⁻¹ and average post-operative haemoglobin level was 105 g L⁻¹. The post-operative Hb level was used as a retrospective indicator for the requirement for blood transfusion. The results show that overall 75% of patients had post-operative haemoglobin levels ≤ 110 and 33% of patients with Hb levels < 100, respectively. These results suggest that preoperative autologous blood deposition may be appropriate in the patients undergoing reconstructive gynaecological repair procedures since there was a high rate of usage of autologous blood and low post-operative haemoglobin in a significant proportion of patients.     

Issuing of blood components dispensed in syringes and bar code–based pretransfusion check at the bedside for pediatric patients

BACKGROUND: The pretransfusion check at the bedside is the most critical step for the prevention of mistransfusion in pediatric patients, as well as in adults. The objective of this study was to assess whether a bar code–based patient–blood unit identification system could be applied to the pretransfusion check at the bedside for the issuing of blood dispensed in syringes.
STUDY DESIGN AND METHODS: The issuing of blood components dispensed in syringes and the bar code–based pretransfusion check at the bedside were initiated for pediatric patients in May 2003. The number of blood components transfused to pediatric patients and rate of compliance with electronic bedside verification for blood dispensed in syringes were determined. Several variables in blood samples that were freshly collected, irradiated, split into 20-mL aliquots, and stored in syringes at 4°C were measured.
RESULTS: Between May 2003 and April 2007, a total of 3957 blood components (10% of all transfusions) were administered to pediatric patients without a single mistransfusion, of which 871 (22%) were issued by dispensing in syringes. The compliance rate with electronic bedside verification for blood dispensed in syringes was 99%. The supernatant potassium concentrations and extracellular free hemoglobin in blood samples stored in syringes at 4°C for 24 hours were 14 ± 1.3 mmol/L and less than 0.3 g/L, respectively, and these were considered to be acceptable for transfusion to pediatric patients.
CONCLUSION: The bar code–based identification system that we used was fully applicable to the pretransfusion check at the bedside for blood dispensed in syringes.     

Impact of intraoperative red blood cell salvage on transfusion requirements and outcomes in radical prostatectomy

BACKGROUND: Preoperative autologous blood donation lowers preoperative hemoglobin (Hb) levels, and the collected blood is frequently wasted. Intraoperative red blood cell (RBC) salvage provides fresher autologous blood in proportion to surgical blood loss, making cell salvage (CS) in radical prostatectomy (RP) feasible for study.
STUDY DESIGN AND METHODS: This retrospective study compared two strategies to reduce allogeneic RBC transfusion requirements in RP: preoperative autologous donation (PAD) versus CS. Patients underwent RP by one surgeon at one institution during two comparable time periods in 2005 (PAD—Group 1) and 2006 (CS—Group 2).
RESULTS: Group 1 patients (n = 40) underwent PAD, collecting 63 autologous RBC units; 36 units (57.1%) were reinfused and 27 (42.9%) were wasted. No Group 1 patient received allogeneic blood. Group 2 patients (n = 63) underwent intraoperative CS and received a mean of 287 mL of salvaged blood. In Group 2, two patients (3.2%) with preoperative Hb levels too low to permit autologous donation each received 2 units of allogeneic RBCs. Group 1 patients had significantly lower preoperative (−1.4 g/dL) and postoperative (−0.8 g/dL) Hb values compared to the CS group. There were no significant differences between groups in procedure times, length of stay, or numbers of cancer recurrences over the 24- to 36-month follow-up period.
CONCLUSION: Perioperative CS can effectively replace PAD for RP patients, offering similar avoidance of allogeneic transfusion, with greater convenience and superior postoperative Hb levels.