Costs associated with blood transfusions in Sweden--the societal cost of autologous, allogeneic and perioperative RBC transfusion

Anaemia is characterised by an insufficient number of red blood cells (RBCs) and might occur for different reasons, e.g. surgical procedures are often with associated blood loss. Patients who suffer from anaemia have the option of treatment with blood transfusion or medical treatment. In this study, the societal cost, for the case of Sweden, of RBC transfusion using three different techniques, i.e. allogeneic, autologous and intraoperative transfusion, was estimated. The analysis was based on information from interviews with hospital staff at large Swedish hospitals and from published data. The average cost for a 2 units transfusion was found to be Swedish kronor (SEK) 6330 (702 Euro) for filtered allogeneic RBCs and SEK 5394 (598 Euro) for autologous RBCs for surgery patients. Transfusion reactions accounted for almost 35 per cent of the costs of allogeneic RBC transfusions. The administration cost was found to be much higher for autologous transfusions compared with allogeneic transfusions. The cost of intraoperative erythrocyte salvage was calculated to be SEK 2567 (285 Euro) per transfusion (>4 units).     

Differences in post-operative infection rates between patients receiving autologous and allogeneic blood transfusion: a meta-analysis of published randomized and nonrandomized studies

Summary. We have undertaken a meta-analysis of the post-operative infection rates in patients who received autologous blood compared with allogeneic blood. Nine studies published after 1989 were identified, of which seven had sufficient data on transfusion given in the paper to be included, giving a total of 1060 patients. The risk of post-operative infection was greater in the allogeneic group, odds ratio 2.37 (95% confidence interval (CI) 1.6-3.6, P < 0.0001) compared with the autologous group. Allogeneic and autologous blood transfusion should be compared in a large multicentre randomized control trial.     

Cell salvage auto transfusion in total knee replacement surgery

We conducted a prospective, randomized study to assess the impact of cell salvage, auto transfusion on the requirements for allogeneic blood for patients undergoing a total knee replacement (TKR). One hundred consecutive TKR patients were randomly allocated to receive either autologous blood (using cell salvage) or an allogeneic blood transfusion as necessary. Patients allocated to the autologous group were rescued with allogeneic blood if the postoperative haemoglobin fell below 9 g dL⁻¹. Forty-two (84%) of 50 patients in the autologous group required no supplementary blood transfusion. Forty (80%) of 50 patients allocated to receive allogeneic blood required transfusion. There were no detrimental effects of autologous blood transfusion. We conclude that autologous blood transfusion, using the cell saver system, is a safe and effective method of reducing the need for allogeneic blood transfusion and, in doing so, reduces the risk of transmission of infections associated with allogeneic blood transfusion, whilst decreasing demand on precious allogeneic blood reserves.     

Increased serum erythropoietin concentration after allogeneic compared with autologous blood transfusion.

Serum erythropoietin (sEPO) level is known to increase as hemoglobin (Hb) concentration decreases during and after preoperative autologous blood donation (PAD). The endogenous erythropoietin (EPO) production after allogeneic blood transfusion has not to our knowledge, been studied. The aim of the present study was to determine whether there is, after surgery, any change in sEPO concentration after allogeneic blood transfusion, and whether there is any difference in EPO response after autologous or allogeneic blood transfusion. Thirty-one patients approaching total hip-joint replacement surgery, were randomized to receive either allogeneic red blood cells (n = 15) or predeposited autologous whole blood transfusion (n = 16). The relationship between Hb, sEPO, and reticulocytes in the recipients were repeatedly analyzed before, during and after surgery. The Hb followed an expected pattern, with a decreased concentration after PAD in the autologous group, then in both groups after surgery. The sEPO concentration was significantly higher in the allogeneic than in the autologous group on day one and day 4-5 postoperatively. The reticulocyte level, on the contrary, was higher in the autologous patients before, one hour after, and one day after surgery. The study showed a greater increase in sEPO concentration after allogeneic blood transfusion than after autologous blood transfusion. There may be an inverse relationship between sEPO and the reticulocyte level.     

Erythropoiesis-stimulating agents in allogeneic and autologous hematopoietic stem cell transplantation

Introduction: Erythropoiesis-stimulating agents (ESAs) are used in treating cancer- and chemotherapy-induced anemia with the aim of accelerating the recovery of red blood cells (RBCs), reduce the risks associated with RBC transfusions and improve quality of life.

Areas covered: A systematic review has been conducted to examine the current evidence for the efficacy and safety of using ESAs in hematopoietic stem cell transplants (HSCTs).

Expert opinion: Despite the international recommendations for the use of ESAs in treating different malignancies, there is a lack of guidelines for their use in patients undergoing HSCT. An evaluation of published clinical trials shows that there are no available powerful studies concerning the use of ESAs in this setting, with only heterogeneous and small numbers of patients reported so far. Nevertheless, the more robust and intriguing of these data suggest that the ESA’s administration at an appropriate time after the infusion of stem cells may be effective both in autologous and allogeneic HSCTs. New guidelines are required, overseen by an expert in the in the field of stem cell transplantation.     

Combined use of autologous transfusion techniques to avoid allogeneic transfusion in spinal fusion surgery with instrumentation

This study conducted a retrospective review of the medical records of 321 patients to delineate the efficacy of the combined use of autologous transfusion (AT) techniques. Transfusion profiles between an AT and homologous transfusion (HT) group were compared. A much lower proportion of patients were exposed to allogeneic blood in the AT group (13%) than in the HT group (98%, p<0.001). In the AT group, a significantly smaller proportion of patients were exposed to allogeneic blood in patients transfused with three or four AT techniques (8%) than those with one or two techniques (29%, p<0.05). A febrile reaction (11% of patients) after a reinfusion of post-operatively shed blood was the only side effect associated with an AT. In conclusion, an AT is effective for preventing the exposure of allogeneic blood in spinal fusion surgery. The combined use of multiple AT techniques may further improve its efficacy.     

自体血液回输技术的临床应用

目的探讨术中自体血液回输的安全性和效果．方法用自体血液回收机将术野出血回收，经抗凝、过滤、清洗、浓缩后回输。抽取术前静脉血、术中回收血、术后静脉血，进行血常规化验、血液生化检验和血浆电解质检查。结果30例患者平均每例回收原血1028ml，经血液回收机处理后获得浓缩血532ml，均回输给病人。术后血常规、多项血生化检查及血浆电解质检查结果变化不明显。结论自体血液回收机能有效减少术中血液的丢失，减少输血后的并发症及不良反应。     

术中自体血液回收与回输的应用研究

目的探讨自体血液回收技术在血液保护中的作用。方法运用ZITI-2000型血液回收机回收与回输自体血116例,监测术前及术中心率（HR）、平均动脉压（MAP）、动脉血氧饱和度（SpO2）、血红蛋白（Hb）、血细胞比容（Hct）、血小板计数（PLT）的变化,测定红细胞悬液的Hct,记录每例回收血量、回输血量和异体输血率。结果①平均每例回收血3379m l,回输血液1235m l,异体输血率为25.8%。②回输后HR、MAP、SpO2、Hb、Hct显著上升（P〈0.01）,PLT无显著变化。③回输红细胞悬液Hct为0.41～0.49。结论自体血液回收技术是一种安全、可靠的血液保护技术,可显著节约血源和减少异体输血。     

Preoperative predictors of the need for allogeneic blood transfusion in lung cancer surgery

BACKGROUND: The use of blood-saving techniques in elective surgery can produce a favorable cost-benefit ratio only when there is a reasonable likelihood that transfusion will be required. To apply a targeted blood-sparing technique in lung cancer surgery, the patient's preoperative characteristics that predict the use of allogeneic blood transfusion (ABT) in this practice were investigated. STUDY DESIGN AND METHODS: One hundred seventy-three consecutive patients who underwent primary lung cancer surgery were included in this retrospective study. Clinical and epidemiologic variables, lung tumor extension (TNM staging), and surgery type were analyzed by logistic regression to discover the preoperative predictors of ABT. RESULTS: Thirty patients, 17.3 percent of all who underwent surgery and 19.9 percent of those who underwent resolvent surgery, received ABT. Excluding a patient who needed 18 units of RBCs, the number of ABT units required by transfused patients was 1. 93 +/- 0.88 (mean +/- SD). Extensive surgery, patient's age (< or =64 years), and elevated erythrocyte sedimentation rate (>45 mm/hour) were the preoperative variables that influenced the need for ABT. The definitive predictive model was able to recognize 82.3 percent of patients who received ABT and 95.6 percent of those who did not. CONCLUSION: A predictive model can preoperatively identify patients at risk for needing ABT in lung cancer surgery. The model could be utilized to tailor blood-sparing intervention programs.     

Blood transfusion and autologous donation: a survey of post-surgical patients, interest group members and the public

Before planned surgery, patients may choose autologous donation in order to avoid the small, but potential, risks of receiving an allogeneic blood transfusion. This study examined the perceived risks of allogeneic blood transfusions, preferences and willingness to pay for autologous donation and the desired role in the decision-making process in three populations: post-surgical patients, special interest group members and the general public. Quantitative and qualitative data were collected from 206 respondents with the help of computer-assisted semi-structured telephone interviews. Thirty-three per cent of the sample voiced concerns about receiving allogeneic blood transfusions. The risks of hepatitis C virus, human immunodeficiency virus, variant Creutzfeldt-Jakob disease and a haemolytic reaction were perceived as being low, but were rated as numerically higher than those of other life events that have equal probability. Autologous donation was perceived as removing all the risks associated with transfusion, and respondents were willing to pay a median $976 AUD ($664 US) to use this technique. Over 80% of respondents preferred to be involved in making the decision about whether to use autologous donation. Even though autologous donation is not 'risk-free' and the blood supply is very safe, people overestimate the associated risks and have a preference for their own blood. Decision aids presenting balanced information on the advantages and disadvantages of both allogeneic and autologous blood may be required.     

体外肺膜氧合支持治疗患者自体血回输的回顾性分析

目的对11例体外肺膜氧合(ECMO)支持治疗患者自体血回输的回顾分析,探讨自体血回输在体外肺膜氧合支持治疗中的临床应用及疗效评价。方法选择2018年10月—2019年5月行ECMO治疗的患者,在其心肺功能恢复,撤机后,将体外管道内的血液收集于一次性使用塑料血袋内,处理后再进行回输。比较回输前后血液分析及凝血功能的变化,对自体血回输后疗效进行评价;对回收后的血液检测5d内的溶血率及进行细菌培养,对贮存血液质量进行评价。结果行ECMO治疗患者自体血回输后,Hb、Plt结果较自体血回输前明显升高,输血疗效显著;凝血功能无明显变化。自体血在2—6℃环境下保存5 d内溶血率远低于国家血液质量标准,连续5 d细菌培养无菌生长,所有患者均未发生输血不良反应。结论行ECMO治疗的患者自体血回输疗效显著、安全可靠、费用低廉。随着ECMO技术的推广,为避免血液浪费,有效节约血液资源,切实降低输血风险,自体血回输技术可广泛应用于ECMO患者。     

Implementation of an electronic identification system in the setting of perioperative autologous cell salvage transfusion: Experience at a university hospital

Perioperative autologous cell salvage (PACS) is one of the effective strategies in patient blood management (PBM). However, mistransfusion, in which the wrong blood is transfused to the wrong patient, of PACS units has been reported. In this study, we implemented a bar code-based electronic identification system (EIS) for blood transfusion in the setting of PACS transfusion. Between February 2009 and December 2020, a total of 12341 surgical patients (9% of whom received surgical interventions) received blood transfusion, among whom 6595 (54 %) received autologous blood transfusion alone, 2877 (23 %) both autologous and allogeneic blood transfusions, and 2869 (23 %) allogeneic blood transfusion alone. Among autologous blood conservation techniques, PACS units were transfused to 7873 patients (83 %) without a single mistransfusion. Rates of overall compliance with the electronic pre-transfusion check at the bedside for all autologous units and PACS units were 98.8 and 98.5 %, respectively. Our observations suggest that a bar code-based EIS can be successfully applied to PACS transfusion, as well as allogeneic blood transfusion in operating rooms.     

Effect of packed red blood cells transfusion on plasma fibronectin during liver resection

Our study aimed at evaluating the effect of blood transfusion - allogeneic or autologous - on plasma levels of fibronectin during liver resections. Thirty-five patients scheduled for liver resection were randomly allocated to receive autologous (group autologous blood transfusion (ABT), n= 19) or allogeneic (homologous) (homologous blood transfusion (HBT), n= 16) packed red blood cell to maintain serum haemoglobin concentration above 9 g. Serum levels of fibronectin were measured before induction of anaesthesia, at the end of operation and at first, third and sixth postoperative day. Perioperative morbidity and survival rate were also recorded. Serum fibronectin levels were significantly higher (P < 0.05) in the autologous group than in the allogeneic, at the first (134 +/- 49 microg mL(-1) vs. 89 +/- 31 microg mL(-1)) and third (178 +/- 51 microg mL(-1) vs. 96 +/- 41 microg mL(-1)) postoperative day. No differences in survival and complication rate between the two groups were observed. Concentrations of serum fibronectin seem to be adversely affected by allogeneic blood transfusion during liver resection surgery, although this does not seem to affect patients' morbidity and mortality.     

不同自体输血方式的临床效果研究

目的 探讨不同自体输血方式的有效性,促进医疗机构开展自体输血工作,保障临床输血安全.方法 采用简单随机抽样法随机选择2014年1月至2016年7月,于北京军区总医院或大连中心医院行骨科手术的88例自体输血患者作为研究对象.采用简单随机分组法,将其随机分为,术中自体红细胞回输组(n=43),储存式自体全血回输组(n=25)及储存式自体单采红细胞回输组(n=20).采用简单随机抽样法,选择同期42例于受试者收集医院行骨科手术,并且术中仅接受异体输血的患者,纳入对照组(n=42).记录并分析采血前/术前、输血后当天、输血后第4天,各组患者红细胞计数、血红蛋白(Hb)水平、血细胞比容(HCT)、血小板计数,以及患者住院天数、术中出血量、异体输血量等指标.采用统计学方法比较4组患者上述各项指标的差异.结果 ①本研究4组患者采血前/术前的红细胞计数、Hb水平、HCT、血小板计数分别比较,差异均无统计学意义(P＞0.05).②输血后当天:4组患者的红细胞计数、Hb水平、HCT分别比较,差异均无统计学意义(P＞0.05);4组患者的血小板计数比较,差异有统计学意义(F=4.157,P=0.008).其中,储存式自体全血回输组患者的血小板计数最高[(196.0±43.8)×109/L],高于术中自体红细胞回输组、对照组,并且差异均有统计学意义(P=0.004、0.009);但是,与储存式自体单采红细胞回输组比较,差异无统计学意义(P=0.653).③输血后第4天:4组患者的红细胞计数比较,差异无统计学意义(P＞0.05);4组患者的Hb水平比较,差异有统计学意义(F=3.764,P=0.013).其中,术中自体红细胞回输组的Hb水平最高[(115.6±23.8)g/L],高于储存式自体全血回输组及对照组,并且差异均有统计学意义(P=0.022、0.006);但是,与储存式自体单采红细胞回输组比较,差异无统计学意义(P=0.878).4组患者的HCT比较,差异有统计学意义(F=3.915,P=0.011).其中,储存式自体单采红细胞回输组HCT最高[(34.4=4.8)％],高于对照组,并且差异有统计学意义(P=0.012);但是,与储存式自体全血回输组及术中自体红细胞回输组分别比较,差异均无统计学意义(P=0.059、0.819).④4组患者术中出血量和异体输血量分别比较,差异均无统计学意义(P＞0.05).4组患者住院天数比较,差异有统计学意义(x2=11.990,P=0.007).其中,对照组患者的住院天数最长[14.5 d(9.5～16.0 d)],长于储存式自体全血回输组,并且差异有统计学意义(P=0.007);但是,与储存式自体单采红细胞回输注及术中自体红细胞回输组分别比较,差异均无统计学意义(P=0.09、0.944).结论 临床择期外科手术患者的自体输血方式,首选储存式自体单采红细胞回输,其次为储存式自体全血回输和术中自体红细胞回输.在不能达到自体输血要求时,可选择异体输血.临床医师需要转变观念,逐步降低异体输血率,广泛、有效地开展自体输血工作,进一步保障临床输血安全.     

Evaluation of awareness and utilization of an autologous blood transfusion programme

Autologous blood transfusion (ABT) has an important role in transfusion practice in the developing world due to increasing incidence of HIV and hepatitis C virus infection. Our study was done to evaluate the level of awareness and utilization of an autologous blood transfusion programme in a teaching hospital in Delhi. We assessed the level of awareness of preoperative ABT amongst treating physicians from different specialties in a teaching hospital through an anonymous questionnaire. The utilization of this methodology in transfusion practice was estimated from records of the Blood Transfusion Service.
Of the 150 doctors contacted 96 (64%) responded. Although 67.7% of them were aware of the technique and its advantages, only 21.8% used it for the patients under their care. In the preceding 24 months 133 (1.1%) of 12 090 blood collections in the transfusion service were from autologous donor-patients. Only one unit of blood was collected from each patient, although 41.8% of them received  2 units of blood. Of the 11 123 patients transfused, 55 (0.49%) received the ABT. Thus only 55 (41.3%) of 133 total ABT collections were utilized. The study highlights that there is a general lack of awareness about ABT amongst physicians. This transfusion practice is rarely and inadequately used. The study was repeated the following year after an intensive intervention strategy was adopted. The results show a trend towards improvement in the practice of ABT. This study emphasizes the need for proper organization, planning and communication between clinicians and blood transfusion personnel for effective implementation of an ABT programme, especially in countries with a high incidence of transfusion-transmitted infections and acute shortages of blood for transfusion.     

自体血回输在异位妊娠内出血中的运用（附17例分析）

目的 探讨自体血回输在异位妊娠内出血急诊手术中的运用价值.方法 2004年10月至2005年10月,采用京精-2000型自体血液回收机对17例异位妊娠内出血病人进行术中自体血回输.分别记录术中出血量和回收血量.结果 17例患者共回收自体血24053ml,回输血12290ml,所有患者均顺利恢复,无自体输血相关并发症.结论 异位妊娠内出血急诊手术中运用自体血液回输安全有效,可迅速获得大量新鲜红细胞,有效地维持循环,减少术中血液丢失,减少异体血输入量和降低输血后并发症,提高抢救成功率.     

A survey of autologous blood transfusion practices in Germany

This survey was designed to evaluate the use of autologous blood transfusion techniques in Germany in 2000 and to identify how the use of these techniques has changed over the past 5 years. Questionnaires were mailed to the chief anaesthesiologists of 400 randomly selected German hospitals with > or =25 surgical beds. Information was sought about the current and past use of preoperative autologous blood donation (PABD), acute preoperative haemodilution and peri-operative blood salvage. Data were requested for the calendar year 2000. Three hundred and forty-three (86%) completed questionnaires were returned. PABD, haemodilution and peri-operative blood salvage were used by 85, 54 and 67% of respondents, respectively. Thirty-seven per cent of PABD users reported that PABD use declined, 28% reported that it increased and 34% reported that it remained unchanged over the past 5 years. The proportions of those reporting declining vs. increasing use of PABD did not differ significantly (P = 0.09). Sixty per cent of users of haemodilution reported that its use declined, 10% reported that it increased and 29% reported that it remained unchanged over the past 5 years. Sixteen per cent of hospitals that were equipped with cell-washing devices reported that the use of these devices declined, 47% reported that it increased and 37% reported that it remained unchanged over the past 5 years. The results indicate that autologous blood transfusion techniques were widely used in Germany in 2000, with PABD being the most common technique. The use of PABD did not change significantly, the use of haemodilution declined markedly and the use of peri-operative cell salvage increased markedly during the past 5 years before the survey.