Independent component analysis of generalized tonic clonic seizure

Epileptic seizures are difficult to detect and classify using electroencephalogram (EEG) due to superimposed muscle artifacts. The objective of this study is to determine features that could differentiate the abnormal EEG activity due to epileptic seizure from a normal background activity. A study group of 20 subjects suffering from a commonly occurring primary epileptic seizure, generalized tonic clonic seizure (GTCS) was compared with a control group of 20 subjects without GTCS. Independent component analysis (ICA) was used to extract independent signals from inter ictal EEG signals. Fast Fourier transform was applied to the independent components and the features were extracted. Wilcoxon rank sum test was performed to find the spectral features that could classify abnormal activity from normal activity. Mean, median, fifth percentile and power in range 2.5–4.5 Hz with P< 0.001 were the features that could differentiate abnormal activity from normal activity. Coefficient of variation, median absolute deviation, 95th percentiles were not able to differentiate normal from abnormal activity.     

The use of a hydrodynamic bench for experimental simulation of flushing venous catheters: impact on the technique

Venous catheters have to be steadily flushed during or after or between intravenous therapies using syringes and thus needing a motion of the hand to push the syringe plunger that can be responsible for a less efficient process. The aim of the study is to show, from experimental simulations, that the dynamic of the flow can have a marked effect on the kinetic of desadhesion of deposit along the duct. The method consists to impose permanent or intermittent controlled flow conditions in a transparent rectangular test section thus permitting easy observation and real time video recording of the desadhesion processes. Evaporating a suitable solid suspension previously carries out a special solid deposit. The results, although qualitative, show that the nature of the flow have a marked influence on the kinetic of desadhesion of the solid deposit. Namely, in identical conditions, a pulsed component of the flow leads to a significative reduction of the time scale of desadhesion during the first moments of the flushing. This preliminary approach leads to the conclusion that the efficiency of the flushing is clearly dependent on the time characteristic of the flow. The flushing fluid volume being fixed by the syringe volume, the definition of a strict protocol is then of prior importance for obtaining a reproducible optimized and standardized motion of the hand.

Résumé

La cathétérisation d'une voie veineuse périphérique ou centrale, pour administrer médicaments et solutés, est une pratique de soin fréquente qui recouvre une variété de situations. Parmi les différents actes d'entretien du cathéter, le rinçage tient une place importante avec un objectif crucial : éviter l'occlusion du dispositif. Nous présentons une simulation expérimentale du lavage de cathéters veineux qui montre que la dynamique du flux de lavage, c'est-à-dire le mode d'administration, peut avoir un effet marquant sur la cinétique de désadhésion du dépôt, c'est-à-dire sur l'efficacité du rinçage. La méthode consiste à imposer des conditions contrôlées d'écoulements stationnaires ou instationnaires dans une section test transparente préalablement recouverte d'un dépôt granulaire opaque. L'enregistrement vidéo permet de suivre en temps réel la cinétique de désadhésion. Les résultats, bien que qualitatifs, montrent que la nature du flux de lavage peut avoir une influence déterminante sur la cinétique de désadhésion d'un dépôt solide. En particulier, toutes choses égales par ailleurs, une composante pulsée de la vitesse du flux de lavage réduit notablement l'échelle de temps de désadhésion dans les premiers instants du lavage. On conclut de cette étude préliminaire que l'efficacité du lavage est moins dépendante du volume de fluide utilisé que de la technicité du geste.     

Adhesion of sickle red cells to endothelium: Myths and future directions

Sickle RBC are abnormally adherent to vascular endothelial cells. We briefly review the mechanisms that underlie this type of cell/cell adhesion, expose a number of extant myths about RBC adhesion, and discuss some aspects that need consideration via future experimentation. The relationship of this phenomenon of RBC-endothelial adhesion to the cytoadherence of parasitized sickle RBC is not yet clear.     

Efficacité et performance des substituts osseux pour remplacer les allogreffes et autogreffes

Although bone tissue possesses the capacity for regenerative growth, the bone repair process is impaired in many clinical and pathological situations. For example massive bone loss caused by trauma and tumor resection as well as deformities require reconstructive surgery. In this context, there was a critical need to develop implant technologies to promote bone healing. Cortical and cancellous bone grafts are the materials of choice for bone filling or reconstruction, but their clinical use involves some difficulties. Septic complications, viral transmission and unavailability of native bone have therefore led to the development of synthetic bone substitutes. Allograft bone, or tissue harvested from a cadaver, while more readily available, may carry with it the risk of disease transmission and is also difficult to shape [1–3]. A significant additional limitation of allograft bone is the delayed remodeling by the host. In the case of very large defects, the allograft may remain in the implant site throughout the patient's life, creating an area more prone to fracture or infection. The development of calcium phosphate ceramics and other related biomaterials for bone graft involved a better control of the process of biomaterials resorption and bone substitution. Synthetic bone graft materials available as alternatives to autogeneous bone for repair, substitution or augmentation, in particular synthetic biomaterials include, special glass ceramics described as bioactive glasses; calcium phosphates (calcium hydroxyapatite, HA; tricalcium phosphate, TCP; and biphasic calcium phosphate, BCP). These materials differ in composition and physical properties from each other and from bone; and must be take in consideration for more efficient bone ingrowth at the expense of the biomaterials and to adapt to new development of dedicated biomaterials. In the last decade synthetic calcium phosphate materials, principally calcium hydroxyapatite (HA) ceramics, was commercially used. However the concept of bioactivity (release of ions of biological interest) well described for glass ceramic was not particularly take in account for HA and other related biomaterials(ACP Amorphous Calcium Phosphate, CdA Calcium Phosphate deficient Apatite). HA until recently was considered to be non able to be resorbed. Calcium phosphate biomaterials differ in their solubility or extent of dissolution: ACP > > α-TCP > > β-TCP > CdA > > ACP. These ceramics are osteoconductive (act as a support for new bone formation requiring the presence of porosity) and able to be resorbed (degradable through chemical and cellular processes). They are also biocompatible (do not induce adverse local tissue reaction, immunogenicity or systematically toxicity); and more recently, some papers report osteoinductive properties associated to the chemical nature (biphasic Ca P) and the microstruture. Past decade, these bioceramics have been marketed and approved for use in humans as bone substitutes. Various presentations are currently used in orthopaedic and maxillo-facial surgery such as wedges, blocks or granules. Owing to their bone substitution properties, CaP ceramics have naturally been considered as a potential matrix for tissue engineering and the development of a bioactive drug delivery system (DDS) in bone sites. The paper presents the current knowledge on Calcium phosphate bioceramics, Bone tissue engineering and Calcium Phosphate Drug Delivery.     

The Eye-Care PC

Myopia is a serious consequence of continuous usage of the computers for long hours and inappropriate sitting distance from the monitor. The proposed Eye-Care PC will help to reduce the child's risk of suffering from myopia and allow parents to monitor their child's computer etiquette conveniently.

Résumé

La myopie est une conséquence sérieuse de l'usage des ordinateurs sur de longues périodes et lorsque l'on est assis trop près. Le dispositif proposé est destiné à réduire le risque de myopie des enfants en fournissant à leurs parents un moyen de contrôle simple de l'usage correct de l'ordinateur.     

Gestion des risques liés à l’achat des dispositifs médicaux

The objective of this study is to integrate a risk and management approach applied to a medical equipment purchasing department. Nowadays, advantages and success of such an approach are well-known. The purpose is to propose a general and adaptive approach, which can be used in any biomedical organization. Different management tools are described such us analysis, assessment, and risk control of the purchasing procedure.     

Detection of serum hemolysins in autoimmune hemolytic anemia

BACKGROUND: Some patients with autoimmune hemolytic anemia (AIHA) have in their sera autohemolysins able to hemolyze RBCs in vitro by activation of complement. We describe three autohemolysins in patients with AIHA and we study clinical correlations. STUDY DESIGN AND METHODS: Thirty-two patients with AIHA were explored by immuno-hematological investigations (DAT, elution and serum testing). RESULTS: Three autohemolysins were detected in three patients. All of these autoantibodies were likely IgM and reacted in vitro only with enzyme-treated RBCs. Two warm autohemolysins were detected in patients with warm-type AIHA. The first one was active at neutral pH with low title. The second, having a wide thermal amplitude reacting at 22 degrees C and a title of 16, was acid. The hemolysin detected in patient 3 with cold hemagglutinin disease, was active at 4 and 22 degrees C, at acid pH. The thermal optimum was 4 degrees C and the title 64. It was also detected at 37 degrees C with the same title, but only at neutral pH. CONCLUSION: Although these autohemolysins were incomplete, hemolyzing in vitro only enzyme-treated RBCs, they were associated for the three patients with severe hemolysis.     

Mouse models of sickle cell disease

In the absence of a natural animal model for sickle cell disease, transgenic mouse models have been generated to better understand the complex pathophysiology of the disease and to evaluate potential specific therapies. In the early nineties, the simple addition of human globin genes induced the expression of hemoglobin S (HbS) or HbS-related human hemoglobins in mice still expressing mouse hemoglobin. To increase the proportion of human hemoglobin and the severity of the mouse sickle cell syndrome, the proportion of mouse hemoglobin could be decreased by a combination of mouse alpha- and beta-thalassemic defects, leading to complex genotypes and mild disease. Following the discovery of gene targeting in the mouse embryonic stem cells (ES cells), it was made possible to knock out all mouse adult globin genes (2alpha and 2beta) and to add the human homologous genes elsewhere in the mouse genome. In addition, the human gamma gene of fetal hemoglobin was protecting the fetus from HbS polymer formation. Accordingly, the resulting adult mouse models obtained in 1997, expressing human HbS-only, had a very severe anemia (Hb=5-6 g/dL). In order to survive, these "HbS-only mice" had to reduce the HbS concentration within the red blood cells. The phenotype could be less severe by adding modified human gamma genes, still expressed in adult mice. In 2006, a last "S-only" model was obtained by homologous knock in, replacing the mouse globin genes by human genes. This array of models contributes to better understand the role of different interacting factors in the complexity of sickle cell events, such as red cell defects, changes in blood flow and vaso-occlusion, hyperhemolysis, vascular tone dysregulation, oxidations, inflammation, activation and adhesion of cells, ischemia, reperfusion... In addition, each model has an appropriate usefulness to evaluate experimental therapies in vivo and to perform preclinical studies.     

Red cell transfusion in medicine: Future challenges

Many side-effects of red blood cell transfusion have been described. They include iron-overload, as well as allo- and autoantibody formation against red cells. During storage, erythrocytes undergo complex structural and biochemical changes. It has been suggested that accelerated and/or aberrant forms of the physiological erythrocyte aging process underlie the red cell storage lesion. This storage lesion may contribute to side-effects of transfusion as endothelial damage by release of internal erythrocyte constituents, (pro)inflammatory consequences, hampered microcirculation and oxygen delivery. Understanding the process that determines the fate of red blood cells after transfusion may contribute to the prevention of side-effects after red blood cell transfusion. This should be the focus of research on red blood cell transfusion in clinical transfusion medicine.     

Platelet additive solutions: A future perspective

Platelet additive solutions (PASs) were first developed in the 1980s, and continued to be improved over the following years. The use of PASs as replacement for plasma has a number of benefits, both for the quality of the platelet concentrates and for the patients. However, some PASs have been associated with a lower platelet yield in the PCs, a shorter storage time, and a lower increment in the patient when compared to PCs in plasma. A number of reformulations of the PASs have taken place to counteract these disadvantages. Most PASs use acetate as nutrient for the platelets, which has the benefit of generating bicarbonate when oxidized by the platelets, thus supplying its own buffering capacity. Alternatively, glucose is used, but may cause deterioration of pH in the stored PCs due to the formation of lactic acid. Addition of other buffering substances, such as phosphate, can be added to ensure maintenance of neutral pH. An important finding was the inhibiting effect of potassium and magnesium on platelet activation. The initially developed PASs lacked these two ingredients and showed reduced storage times of the PCs in PAS when compared to those stored in plasma. However, when these constituents are included in the PAS, storage time is similar and even exceeds those seen for PCs in plasma. Considerable research is done in further formulating the optimal PAS. Bicarbonate is being considered as buffer for these PASs. Also, L-carnitine appears to have a favorable effect on stored platelets, including a reduction of platelet metabolism, and inhibition of apoptosis. Another area of optimization is lowering of plasma content needed for maintaining platelet quality. Where current PASs still need at least 30% residual plasma, there is a trend towards lowering the plasma content to less than 5% with the newer PASs. Preservation of purinergic platelet receptor functionality by ADP-degrading activities in plasma appears to play an important role in this respect. Development of PASs are usually based on in vitro studies alone. It is important to realize that only clinical studies can give definitive answers about the quality of platelets stored in PASs. Sofar, only limited clinical evaluations have been published that either studied the effectiveness of platelets in initially-developed PASs, or were specifically done in combination with pathogen reduction technologies. Thus, PASs seem to be an excellent replacement for (part of) the plasma when producing PCs, and allow extended storage with maintenance of quality, but more clinical studies are needed to substantiate in vitro results.     

The role and impact of the transfusion medicine consultation service in the management of patients in the hematopoietic transplant service: A retrospective analysis

BackgroundAdverse reactions secondary to transfusion of incorrect blood components can be fatal. We have established numerous processes to prevent these reactions in patients with cancer who continuously need blood component support, especially hematopoietic transplant recipients. The development of an active transfusion medicine consultation service at our institution to serve patients undergoing hematopoietic transplantation has led to more organized and simpler management of providing blood components to such patients.Study design and methodsSafety tools were employed to attain our goal of providing safe blood components to hematopoietic transplant recipients. These tools were consultation request forms, blood component selection stickers on the patients’ charts, and transfusion medicine physician consultation notes posted in the patients’ medical records. One hundred randomly selected hematopoietic transplant recipients were reviewed over 16 months. Fifty patients received blood components from ABO-compatible donors, whereas the other 50 patients received components from ABO-incompatible donors. Deviation reports regarding the issuance of blood components in these patients over the study period were reviewed retrospectively.ResultsWe identified eight reported deviations from the recommended blood components: red blood cells in one case, fresh frozen plasma in one case, single donor platelets in one case, and random donor platelets in five cases. Our transfusion service issued all eight components, but none of them were transfused. In all eight cases, the blood components were intended for transfusion to ABO-mismatched hematopoietic transplant recipients. Nurses identified the incorrect blood components by verifying the recommended blood groups on the patients’ chart stickers, returned the components to the transfusion service, and transfused the correct blood components.ConclusionUse of these safety tools has improved the safety culture regarding transfusion of blood components in hematopoietic transplant recipients at our institution.     

Mycétomes diagnostiqués au Sénégal de 2008 à 2010

Introduction

Mycetomas are inflammatory pseudotumours of subcutaneous and possibly osseous soft fabrics, generally polyfistulas with chronic mode of evolution.

Patients and methods

This study was carried out at the laboratory of parasitology and mycology of Le Dantec hospital in Dakar, Senegal, including 113 patients, from june 2008 to july 2010.

Results

Patients were from different regions in Senegal and in neighborhood countries, referred to the laboratory for mycetoma diagnosis. Among the 250 patients referred, 113 were positives after direct observation and culture corresponding to 45.2% index of infestation. The age range varies between 13 to 73 years with an average age of 33.9 years. The age bracket ranging between 20–39 years is more infected (27.34%), followed by 40–59 years (25.2%), 60 years and more (4.5%), 30–39 years (16.64%), 13–19 years (7.2%). The infection sex rate were, male: 79.6% and female: 20.4%. Infection prevalence profession dependant was found mainly in farmers and breeders with respectively: 48.7%, and 42.5%. The foot infestation is most represented with 72.5%, then leg (12.3%), knee (7.1%), scalp (2.7%), hand (1.8%). The other localizations are found with less than 1%: back, thigh, chest and ganglion inguinal. According to mycetoma agents, fungy are represented than mycetomas actinomycosic with respectively 70% and 30%. The species found were: Madurella mycetomatis (53.1%), Actinomadura pelletieri (23%), Leptosphaeria senegalensis (9.7%), Streptomyces somaliensis (2.6%), Actinomadura madurae (2,6%), Pseudallescheria boydii (1.8%), Nocardia spp. (1.8%), Scedosporium apiospermum (0.9%), Fusarium solani (0.9%). We found agents of dermatophytes: Microsporum langeronii (1.8%), and Trichophyton mentagrophytes (0.9%).

Conclusion

This study confirms that mycetomas are endemic affections in Senegal, where it still remain a real cause of disability among population leaving in rural area.     

Consensus and controversies in platelet transfusion: Trigger for indication, and platelet dose

Platelet transfusion is about to commemorate its 50th year since its introduction in therapeutics. It is then surprising to see, that in spite of reaching this respectful age, we have not been able to definitely establish all the aspects related to its clinical use. Some of these facets are platelet transfusion threshold and the platelet dose to administer. Historically, two different transfusion triggers have been used for prophylactic and therapeutic platelet transfusions. For prophylactic platelet transfusion an increasing body of evidences suggests that a transfusion trigger of 10 x 10(9) per liter is appropriate for most clinical settings. In contrast, evidence for supporting a certain therapeutic transfusion trigger is lacking. Nevertheless, there is consensus that the platelet count should not be allowed to fall below 50 x 10(9) per liter in patients with acute bleeding. Another important aspect still pending of clear definition is the issue of the platelet dose to be transfused. It has been addressed by some small studies but a definite answer to this important clinical issue is, at least so far, still pending. The results of two ongoing trials, one sponsored by NIH through the Clinical Trials Network in Transfusion Medicine and Hemostasis and the other promoted by the BEST Collaborative Group are expected to help us to clearly defining the more effective and efficient way to transfuse platelet concentrates.     

Clinical effects of different types of red cell concentrates in patients with thalassemia and sickle cell disease

The treatment of thalassemia is still essentially based on continuous transfusion supporting using red cell concentrates (RCC) prepared in different ways. For patients with sickle-cell disorders, either urgent or chronic red blood cell transfusion therapy, is widely used in the management of sickle cell disease (SCD) because it reduces HbS level and generally prevents recurrent vaso-occlusive disease (VOD). Recently, the introduction of pre-storage filtration to remove leukocytes and the use of techniques for multicomponent donation have increased the types of blood components available for transfusion purposes. The clinical effects of different types of blood components in thalassaemic and sickle-cell patients have not been extensively studied so far. We evaluated the impact of the various different blood components currently available on transfusion needs, transfusion intervals and adverse reactions in order to determine which is the most advantageous for transfusion-dependent thalassaemic and sickle-cell patients followed in our centre. We believe that the optimal characteristics of the RCC are aged less than 10 days from time of collection; Hb content greater than 56 g per unit; Hct: 55-60%; volume (including additive) 300 mL+/-20%; leucodepleted to less than 200,000 leukocytes per unit; low cytokine content (achievable by pre-storage filtration carried out between two and 24 hours after the collection); lack of microaggregates (achievable by pre-storage filtration or filtration in the laboratory) and protein content less than 0.5 g per unit for patients allergic to plasma proteins (achievable with manual or automated washing). It is still recommended that the blood transfused should be as fresh as possible, compatible with the centre's product availability and the centre's organisation should be continuously adapted to this aim. We always transfuse blood within 10 days of its collection, respecting Rh and Kell system phenotypes. Pre-storage filtration is strongly recommended, both in order to prevent adverse reactions through the marked leucodepletion (less than 200,000 leukocytes per unit) and for a better standardisation of the final product, including the certainty that the product does not contain clots, an assurance that bed-side filtration cannot give. The RCC should be produced using a method causing as little as possible stress to the red cell membrane. The use of RCC with a high content of Hb (less than 56 g per unit) is strongly recommended, because our study clearly shows that this reduces the number of exposures to donors and the number of accesses to hospital, thus improving the patient's quality of life.     

Use of random versus apheresis platelet concentrates

The respective use of random (RPC) and apheresis (APC) platelet concentrates is highly heterogeneous among countries, ranging from 10 to 98% RPC in countries supposed to provide a similar transfusion service to patients. Moreover, when considering each country in the past 10 years, one can observe that some have changed their policy, switching from a majority of APC to RPC or vice versa. This presentation intends to analyse which factors may impact such decisions. For many years, the only available platelet component was a RPC obtained from whole blood donation by a two centrifugation steps process, the "platelet rich plasma" or PRP method. Since the beginning of the 1970s, APCs became available, with in fact many different techniques leading to many APCs that may not be equivalent. Since the end of the 1980s, a new method of RPC preparation was developed, using the buffy-coat (BC-PC), providing a blood component with highly preserved platelet functions as compared to RPCs prepared by the PRP technique. Finally, the use of each of these components either native, or leuco-reduced, or suspended in a storage solution, or processed with a pathogen inactivation technique adds new layers of complexity to compare them. Innumerable references can be found in the literature describing in vitro functional parameters of platelet concentrates. Although it is clear that BC-RPC retain much more their in vitro functions than PRP-RPC, indicating that no one should use the latter any more, it is much more difficult to distinguish differences between other PCs. Conversely, only a very few studies have been published related to a comparison of clinical efficacy of RPC versus APC, the endpoints being mainly CCI. Similarly to the in vitro studies, although RPC prepared with the PRP method show the lowest CCIs, no clear difference exists between "modern" RPC and APC. Another factor that may impact policy decision is the occurrence of adverse reactions in recipients. When considering only comparable data, for example leuco-reduced RPC versus leuco-reduced APC, there is now evidence that the latter is more associated with adverse reactions in recipients: data from hemovigilance in France show that, although no difference is noted for febrile non haemolytic transfusion reactions, nor for bacteria contamination, the incidence of allergic adverse reactions is about four times higher with APC as compared with RPC. Other aspects may impact the decision: the fact that using APC in place of RPC reduces the total donor exposure of patients was considered critical in some countries to reduce the risk of transmission of blood transmissible disease. Finally, the cost of the components, much higher for APC may be considered.     

Cys shotgun labeling of macrophages adhering to and engulfing Ig-opsonized cells

A method is being developed to study cytoskeletal reorganization in cell adhesion processes. The initial model process is adhesion and phagocytosis of beads or red blood cells by macrophages. Live cell labeling with Cys reactive fluorophores is performed before and during phagocytosis with different color labeling dyes. Since Cys is a relatively hydrophobic amino acid, its differential exposure and labeling in principle reflects changes in tertiary or quaternary structure of specific proteins. Similar studies conducted on red blood cells under fluid shear conditions showed that specific domains in spectrin undergo extensible unfolding within sheared cells. The initial work here with macrophages also suggests some structural changes in phagocytosis although the proteins and specific sites have yet to be identified.     

Intérêt de la coopération ostéoendothéliale en ingénierie du tissu osseux

The techniques of bone tissue engineering, associating autologous repairing cells with a bioactive materials must to take into account of the mechanisms of communication which can exist between the cells requested on the level of a site of repair. Among these phenomenons of interaction, vascularization remains closely related to an osseous regeneration. In vitro studies of co-cultures between endothelials cells and osteoblastic cells of various origins let predict existence of different factors (growth factors, peptides natriuretic, nitric oxyde) but also of junction communication responsible for the regulation of the bone formation activity of the osteogenic cells. In addition, the existence of such cooperation could be demonstrated using experimental models of osseous reconstruction. Finally, the contribution of the nanotechnologies of the biomaterials offers very promising prospects to promote these cellular cooperations and these heterotopic communications.     

Cutaneous perception of electrical direct current

We have investigated the threshold level of perception for dc current in human skin in order to determine whether it is best described as a function of current or current density. The threshold was found to be more dependent on current than current density, and a spatial summation effect in the nervous system is suggested as one possible cause of this finding. The perception typically persisted for a long time after the current had been switched off, indicating that the nerves are excited by chemical products of the dc current and not by the current itself.

Résumé

Nous avons étudié le niveau de seuil de la perception du courant continu dans la peau humaine afin de déterminer si cette perception est mieux fonction de la densité ou l’intensité du courant. Le seuil s’est avéré plus dépendant de l’intensité que la densité, et une cause possible en est l’effet spatial additif dans le système nerveux. Typiquement, la perception persiste pendant longtemps après que le courant ait été coupé, indiquant que les terminaisons nerveuses sont excitées par les changements biochimiques induits par le courant continu et non par le courant lui-même.     

Autologous blood predonation in cardiac surgery

The risk of transfusion of allogeneic blood products on outcome is well documented. Autologous blood donation prior to elective cardiac surgery has repeatedly shown to be an effective practice to reduce the exposure to allogeneic blood, but was criticized because of the alleged high costs. We analyzed the data of 4878 patients undergoing elective open-heart surgery, in whom 18% underwent autologous donation. Overall, autologous blood donation reduced the incidence of allogeneic blood transfusion from 48 to 13% during hospitalization. Additionally, it is shown that diagnosis adjusted autologous blood donation is cost-effective. The higher the probability of transfusion the better is efficacy and cost-effectiveness of predonation. Cardiac surgery is a high-transfusion area, thus, it offers ideal conditions for autologous donation. Autologous blood donation still remains a promising and cost-effective alternative to reduce allogeneic blood transfusion in elective cardiac surgery.