Autologous blood donation in cardiac patients

Despite the advantages of autologous blood transfusion, doubt still remains about its safety in cardiac patients. We report our experience with 439 cardiac patients who donated a total of 1692 units of blood before coronary, valvular, or congenital cardiac operations. During the collections, patients were continuously monitored with ECG, blood pressure, and heart rate. In 22 collections we observed vasovagal reactions, which represents an incidence of 1.3% of the total number of collections. The patients recovered quickly and only in 3 cases was volume replacement with saline needed. There were no other complications which could be related to the preoperative autologous donation program. We feel that, with careful selection of the patients and of the circumstances surrounding the collection of blood, autologous blood donation in cardiac patients is a safe and beneficial experience.     

Autologous blood donation: hemodynamics in a high-risk patient population

Transfusion practices have changed dramatically in recent years as a result of the acquired immune deficiency syndrome crisis. The use of preoperative donation of autologous blood units has gained popularity. Healthy individuals tolerate phlebotomy well, experiencing a 2- to 5-percent incidence of vasovagal reactions. However, no systematic study of hemodynamic function during phlebotomy exists for patients who have major cardiovascular or multiple organ disease (high-risk patients). The following protocol examines blood pressure, heart rate, cardiac output, lead II electrocardiogram, and pulse oximetry in 123 patients donating a total of 224 units of blood in a new high-risk autologous blood donation program that was conducted in a postanesthesia care unit over the past 18 months. Changes in hemodynamic variables during phlebotomy were consistent with mild volume depletion; the changes did not result in overall differences in the courses of the groups. Significant numbers of patients exhibited systolic or diastolic hypotension, dysrhythmias, syncope, and tachycardia. Because tolerance for hypotension (vasovagal reactions) is decreased in patients with coronary artery disease, appropriate monitoring may be warranted to maximize the safety of elective phlebotomy. Further study is required to stratify risks and to determine which hemodynamic variables are predictive of adverse events.     

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.     

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.     

Autologous blood donation preceding coronary artery bypass graft operation in a hemodialysis patient.

A 67-year-old male hemodialysis patient with abdominal aortic aneurysm and triple vessel coronary heart disease required autologous blood donation because of his blood type of Rh(-) before cardiovascular surgery. We performed autologous red blood cell and plasma collection by the switch back method with recombinant human erythropoietin therapy during the 5 weeks before the operation. Autologous platelet collection was also made the day before the operation. These autologous blood donations were safely and successfully performed along with hemodialysis. There was some caution taken for these procedures. The ultrafiltration rate had to be adjusted for blood collection or blood transfusion during hemodialysis in order not to disturb fluid balance. It was necessary to monitor the hyperkalemia of the stored autologous packed red blood cells. For platelet collection, blood in the extracorporeal circuit had to be concentrated because of the presence of renal anemia. Coronary artery bypass graft was safely and successfully performed with the autologous blood only.     

Remuneration for blood donation and attitudes towards blood donation and receipt in Leeds

In a survey of attitudes towards remuneration for blood donation in Leeds, the following questions were completed by 489 adults (N), of whom 89 were regular donors, 105 were lapsed donors and 295 had never donated: 'If you needed blood, would you be content if the donor had been paid: yes/no'. 'If I were paid enough I would be less/equally/more likely to donate blood '. The majority (67.7%) of potential recipients would be content if the donor had been paid. The prospect of remuneration made 16.4% of respondents more likely and 14.5% less likely to donate. As the difference is less than 2% of N, offering remuneration may not lead to a significant increase in the number of donations. A statistical comparison (chi2 = 45, d.f. = 2, P < 0.001) showed associations between the responses 'more likely to donate if paid' and 'content to receive blood from a paid donor', and between the responses 'less likely to donate if paid' and 'not content to receive blood from a paid donor'. Age distributions are presented for the donor status categories and the responses to the main questions. Of 129 people who stated a minimum, nonzero payment that would persuade them to donate, 103 (80%) suggested pound sterling 10 or less.