Autologous Blood Donation Elective Surgery in Children

Studies were made on 59 children (cardiac 42, orthopaedic 13, miscellaneous 4) scheduled for autologous blood donation before elective surgery. The donor-patients' ages ranged from 3 to 15 years (mean 9.9 years) and their weights from 13 to 70 kg (mean 34 kg). All patients received 50–100 mg of oral iron sulphate per day. As a rule, about 10% of intravascular blood volume was drawn once a week. Before surgery, an average of 720 ml of autologous blood per patient was prepared. Two patients failed to donate autologous blood because of anxiety about the procedure; however, none of the donors was deferred due anaemia assoicated with the phlebotomy. Of the 53 patients undergoing surgery and participating in autologous predonation, 50 (94%) were able to avoid homologous blood transfusion. 600 ml of homologous blood were transfused to each of 2 orthopaedic patients and 400 ml to 1 cardiac patient. We conclude that a predeposit autologous transfusion programme is logistically possible in small children when the patients are cooperative.     

Transfusion and the risk of hepatitis

Hepatitis is an inevitable risk of blood transfusion. Data concerning the frequency of the disease much deviate from each other, conditioned by epidemiological and clinico-diagnostic differences. From 1979 to 1981 in 273,476 transfusions in the counties of Magdeburg and Erfurt altogether 57 diseases of hepatitis were recognized by the organs of hygiene, which were in temporary connection (6 months) with transfusions. Thus the risk of hepatitis of notified diseases per transfusion unit was 0.02%. 6.1% of all hepatitic affection were in a temporary connection with transfusions, 7.6% were in a temporary connection (6 months) with hospitalization without transfusion. The necessity of repeated clinical examinations of the recipients of blood and blood preparations, the immediate duty of notification to the blood transfusion service when donors and recipients fall ill is emphasized. When individual donations are given the causality of transfusion and hepatitis is not to be proved. The use of the notion transfusion hepatitis which is to be proved by tradition, nowadays, however, done too inconsiderately deviates from other chains of infection and necessary measures.     

Risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis

BACKGROUND/AIMS: Liver resection for hepatocellular carcinoma in patients with cirrhosis carries risk of major hemorrhage and sometimes requires blood transfusion. We investigated risk factors for massive blood loss during liver resection and indications for storing blood for autologous intraoperative transfusion. METHODOLOGY: We analyzed clinical records of 100 patients with cirrhosis who underwent liver resection for hepatocellular carcinoma. Autologous blood was stored preoperatively for 19 patients. RESULTS: Intraoperative blood loss ranged from 5 to 3000 mL (mean, 640). Liver resection was performed without transfusion in 67 patients and with autologous blood storage in 17 patients not receiving homologous blood. In the other 16 patients, homologous blood was transfused. Univariate analysis identified youth, large tumors (> 4cm), major hepatectomy, portal tumor involvement, hepatic vein involvement, and prolonged operation time as risk factors for massive blood loss; multivariate analysis identified portal involvement and hepatic vein involvement as independent risk factors. Blood loss exceeded 1000 mL in the 4 transfused group B patients and 3 of the 4 patients had hepatic vein involvement. CONCLUSIONS: Portal involvement and hepatic vein involvement were risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis. Autologous blood storage is indicated in patients with such risk factors.     

Red Blood Cell Transfusions for Total Hip Replacement in a Regional Hospital: A Six-Year Analysis

To evaluate changes in the need for homologous blood and to assess the impact of autologous blood transfusion, red cell transfusions in unilateral total hip replacement surgery, performed electively in the period 1986–1991, were studied in a regional hospital. Transfusion data, perioperative blood loss and postoperative haemoglobin concentration of 495 patients were analysed. From 1986 to 1991, the percentage of patients not transfused with homologous blood increased from 18.5 to 45.5%. After the introduction of an autologous blood transfusion programme in 1987, 116 of 430 patients (27.0%) donated autologous blood. No increase in the percentage of autologous donors was observed during the study. Most common reasons for nonparticipation were the patient's age, doctors' underordering and logistic limitations. 81.9% of autologous donors had total hip replacement surgery without homologous transfusions. Mean blood loss reduced significantly from 1,373 ± 781 ml in 1986 to 958 ± 582 ml in 1991 (p < 0.001). Transfusion requirement in the nonautologous patients fell from 2.6 ± 1.8 units in 1986 to 1.4 ± 1.4 units per patient in 1989 and increased thereafter to 2.2 ± 2.1 units in 1991 (p < 0.01) and showed a strong correlation with blood loss (r = 0.58; p < 0.001). No changes in postoperative haemoglobin concentration were observed throughout the study. In conclusion, collection of autologous blood is effective, albeit still underutilized, to reduce homologous blood requirement. The close correlation between blood loss and transfusion requirement accentuates the role of surgical practice in the reduction of homologous transfusions.     

The risks of blood transfusion: the relative influence of acquired immunodeficiency syndrome and non-A, non-B hepatitis.

PURPOSE: The acquired immunodeficiency syndrome epidemic has greatly increased concern about the risk of blood transfusion. Many transfusions are now autologous, and when these are not available, both physicians and patients are more likely to question the advisability of transfusion. We evaluate the risk of preoperative blood transfusion and the contribution of human immunodeficiency virus (HIV) infection to that risk. METHODS: We used decision analysis to characterize the risk associated with HIV infection in days of life lost. The contributions to risk of acute transfusion reaction, hepatitis B, and non-A, non-B hepatitis are also estimated. Sensitivity analyses show the implications for transfusion risk of recent information about HIV infection in the blood supply and a new test for hepatitis C. RESULTS: The analysis shows that the contribution of HIV infection to the risk of death from transfusion, expressed in days of life expectancy lost, has become extremely small over the last several years. Currently, HIV infection accounts for less than 1% of the risk of death, while non-A, non-B hepatitis accounts for 97% to 98%. Further reductions in the risk of HIV infection, even to zero, will make relatively little difference in the safety of transfusion. The analysis also shows that the remaining risk from transfusion should decrease sharply, by more than two thirds, with the adoption of the test for hepatitis C. CONCLUSIONS: Efforts to improve the safety of blood should focus on reducing the risk of non-A, non-B hepatitis. The remaining risk of HIV infection is very small.     

Advantages and limits of programmed autologous transfusion in cardiovascular surgery. Apropos of 524 patients]

Between October 1987 and July 1989, 544 patients, candidates for cardiovascular surgery, were included in a trial of programmed autologous autotransfusion. Five hundred and twenty four patients underwent one or several (maximum 4) blood donation sessions in the 3 weeks before surgery with no complications. Overall, 57% of patients benefited from homologous blood transfusion, thereby avoiding all risk of contamination. It was in the group of patients able to undergo 3 or 4 preoperative blood donations that we observed the smallest number of homologous transfusions (30%). Programmed autologous transfusion would seem to be a very useful technique for cardiac surgery, allowing a reduction in health care costs without additional patient risk. In order to improve on this method, it may be useful to associate a peroperative technique of blood recuperation in patients in whom the transfusion needs are likely to exceed the possibilities of preoperative blood donation alone.     

Changing epidemiology of parenterally transmitted viral hepatitis: results from the hepatitis surveillance system in Italy

Background. In 1991, compulsory hepatitis B virus vaccination and screening for anti-hepatitis C virus of blood banks were introduced in Italy.

Aim. To evaluate the impact of preventive measures on the incidence and risk factors for parenterally transmitted viral hepatitis.

Methods. Data from the surveillance system for acute viral hepatitis for the period 1985–1999 were used. Temporal trends in distribution of reported risk factors were analysed by comparing three-year periods: 1987–1989 and 1997–1999.

Results. The incidence fno. cases per 100, 000 population) of hepatitis B was 12 in 1985 and 3 in 1999; the incidence of hepatitis nonA, non-B decreased from 5 to 1 in the same period. These decreases were more evident among young adults and before rather than after 1991. Multiple sexual partners, other parenteral exposures and dental treatment remain the most common risk factors for parenterally transmitted viral hepatitis. An increase in frequency over time was observed for other parenteral exposures, whereas a marked decrease was evident for blood transfusion and household contact with an HB-sAg carrier. Invasive medical procedures continue to represent an important source of infection. Intravenous drug use was reported particularly by young adults with non A, non-B hepatitis, with increased frequency over time.

Conclusions. Non-immunologic measures for preventing hepatitis B and non A, non B due to iatrogenic and other parenteral exposures, combined with hepatitis B virus vaccination, could further reduce parenteral transmission.     

Autologous blood transfusion in elective heart surgery: prospective study of 189 consecutive patients

Blood autotransfusion has entered a new phase in blood transfusion technique, since it represents an important alternative in eliminating the risks connected with blood transfusion: viral hepatitis, AIDS, blood transfusion reactions, and alloimmunization. Transfusion requirements during cardiac surgical procedures have steadily decreased; nowadays most adult patients require no transfusion during surgery. Patients (pts) receiving bank-blood may develop infectious diseases (hepatitis, AIDS, etc.). We have studied how to avoid the risk of infections with homologous blood transfusions. We present our experience of day-hospital pre-operative autologous blood collection. One-hundred-eighty-nine patients undergoing primary myocardial revascularization or valvular replacement were submitted to the drainage of 350 ml of blood three times every four days before surgery. The blood was centrifuged at once, to separate red cells from plasma. Surgeries were performed 21 days after the first drainage; iron therapy was recommended. After surgery pts received blood only if haematocrit was lower than 28%. The following data were recorded: no. of pts who received homologous blood; blood loss and homologous total blood volume used for each pt. Average blood loss was 1230 cc for ischemic pts and 701 cc for valvular pts. Non-A non B hepatitis occurred in 3/189 pts (1.5%). All of them had received homologous blood transfusions. Our data show clearly that autotransfused pts had a better post-operative period; less bank-blood and fewer transfusions have been used. No pt had collateral effects such as angina or hypotension from blood drawing. Our data show that severe cardiac diseases do not represent an absolute contraindication to heavy blood drainage.(ABSTRACT TRUNCATED AT 250 WORDS)     

心内直视手术中输自体血临床研究

１９８９～１９９３年的４年中，共进行心内直视手术时输自体血１７５５例（其中成人１５５５例，儿童２００例），共放出自体血１０５万ｍｌ，平均每例放血６００ｍｌ。患者年龄最小生后６２天，最大７４岁，体重最轻４．５ｋｇ，最重９８ｋｓ。本文推道了临床情况放血方法及一系列临床科研工作。此项工作培养了干部，节约了库血，减轻了患者经济负担和减少手术后肝炎发生的危险，应广为宣传应用。     

The influence of dose of transfusion and component of blood on the incidence of post-transfusion hepatitis

Two thousand five hundred ninety-six consecutive patients who received blood transfusion for the first time within one week and had no liver dysfunction before transfusion had been selected from 8637 patients who received blood transfusion at the hospital between 1982 and 1987. The influence of dose, components of transfused blood and sex, age of recipients on the incidence of post-transfusion hepatitis was investigated. The rate of development of hepatitis depended on the dose of transfusion, not on sex and age of recipients. The rate of development of hepatitis raised as number of transfused blood increased without limiting point to 100%. The carrier rate of healthy population of non-A, non-B hepatitis virus was estimated 1.39%. Stored blood, concentrated red blood cell and fresh blood are high risk components and fresh frozen plasma was low risk component.     

Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the 'Direction Générale de la Santé'.

OBJECTIVE AND DESIGN: Oriented hepatitis C virus (HCV) screening on the basis of transfusion, previous or current parenteral drug addiction, invasive procedures, and in family members of patients with hepatitis C, was recommended in France by the 'Direction Générale de la Santé' (DGS). The aim of this study was to estimate the frequency of these risk factors in patients admitted in hospital emergency departments in Picardy. METHODS: Between 1 June and 31 July 1996, physicians of the emergency units of seven hospitals in Picardy were asked to question admitted patients about risk factors mentioned in the DGS recommendations, and to suggest a screening test when at least one of these risk factors was present. RESULTS: Among 1648 patients, 68.7% had at least one of these risk factors. Screening was accepted by 723 patients, 58.7% of those with at least one risk factor, and more than 70% of those with history of transfusion and/or drug addiction. It was immediately performed in 451, and 2.4% had anti-HCV antibodies. The prevalence of anti-HCV antibodies was 1.5% in patients without history of transfusion or drug addiction and 7.9% in those with at least one of these two risk factors. CONCLUSION: Oriented screening based on transfusion or drug addiction history seems to have better efficiency than the screening policy recommended by the DGS. Poor reliability of answers about medical history was observed probably because of stress related to emergency circumstances. A screening test proposed to patients with these major risk factors by their usual physician would be probably more efficient.     

Prevalence of hepatitis C virus infection in pregnant woman on the island of Réunion]

AIMS: The aim of this prospective study was to assess the prevalence of anti-hepatitis C virus antibodies in a population of pregnant women in Réunion. METHODS: Over a 6-month period, all blood samples of pregnant women who delivered at a hospital in the south of Réunion were tested with a third generation enzyme-linked immunoassay. In addition, risk factors for hepatitis C transmission were systematically looked for. RESULTS: Among the 1,455 women tested during this period, only 2 sera were found to be positive, resulting in a prevalence of 0.14%. One of these women had a history of intravenous drug use, whereas the other had no identified risk factor. This low prevalence was found to be associated with a low frequency of risk factors of C virus infection in this population: a history of transfusion and intravenous drug use was found in 2.9% and 0.21% of cases, respectively. CONCLUSIONS: The prevalence of hepatitis C virus infection is particularly low in Réunion. This low prevalence is explained by the rarity of risk factors for hepatitis C transmission in this region which is close to the African continent and has a similar high prevalence of hepatitis B virus infection.     

Epidemiological information obtained from anti-hepatitis C virus screening in blood donors and candidates for autologous transfusion from 1992 to 1996 in the Alpes-Maritimes region

OBJECTIVES: To determine the evolution of the frequency of anti-hepatitis C virus antibodies from 1992 to 1996 in blood donors and in candidates for autologous transfusion in the Alpes-Maritimes region and to assess risk factors. METHODS: Anti-hepatitis C virus antibodies were assessed by second generation ELISA in 1992 and in the first quarter of 1993, and then by third generation ELISA; in all cases, anti-hepatitis C virus antibodies were confirmed by RIBA test. RESULTS: Since 1992 (when the second generation ELISA test became available), the prevalence of anti-hepatitis C virus antibodies in blood donors in the Alpes-Maritimes region (0.54% in 1992 to 0.20% in 1996) has decreased. Positive ELISA anti-hepatitis C virus was confirmed by RIBA in 53 to 68% of anti-hepatitis C virus blood donations. The percentage of anti-hepatitis C virus donors with ALT above the upper limit (donation exclusion threshold) was between 28 and 56%.The most frequent age interval for new anti-hepatitis C virus positive donors was between 30 and 40 years. Since 1992, a third of the anti-hepatitis C virus blood donors agreed to participate in a medical history questionnaire. One or several risk factors were found in almost all donors. The most frequent source of infection was nosocomial (50%). During the 5 years of the study, the number of candidates for autologous transfusion increased: 717 in 1992 to 1 528 in 1996. The prevalence of anti-hepatitis C virus in this older population (mean age: 64 years) decreased progressively (2.9% in 1992 to 1.1% in 1996, P<0, 01) since the prevalence of anti-HBc remained stable, near 12%. Among the 96 subjects found to be anti-hepatitis C virus positive before an autologous transfusion, 49 were transfused before 1990 and 40 had a history of surgery. CONCLUSION: The prevalence of anti-hepatitis C virus has decreased since 1992 in blood donors and in candidates for autologous transfusion which may suggest that there is better screening in the general population and presenting the spread of hepatitis C virus infection.     

冠状动脉旁路移植术后自体血液回输减少血液制品的应用经验

目的总结非体外循环下冠状动脉旁路移植术（OPCABG）后应用自体血液回输以减少血液制品的经验。方法将2007年8月至2011年8月北华大学第二附属医院心脏外科44例OPCABG患者随机分为自体血回输组（试验组）和异体血输血组（对照组）,每组各22例。试验组应用非洗涤过滤式自体引流血回输;对照组未用自体引流血回输。结果试验组自体引流血液回输量（774．9±278．7）ml,输异体红细胞悬液（744．4±．375．5）ml;对照组输异体红细胞悬液（1200．0±357．9）ml。试验组回输自体血量占输血总量的27．8％～96．0％,平均减少了47．9％以上的异体血输入量。术后随访1个月,两组无一例新桥梗阻及血栓形成,无一例再发心绞痛症状。试验组与对照组输异体血量差异有统计学意义（P〈0．01）,而输异体血浆差异无统计学意义（P〉0．05）。结论OPCABG术后应用一次性回输器回收自体引流血可以显著减少异体血输入量。     

Prevention of hepatitis C in Italy: lessons from surveillance of type-specific acute viral hepatitis. SEIEVA collaborating Group

Using data from the surveillance system for type-specific acute viral hepatitis, the temporal incidence trend of non-A, non-B acute hepatitis and risk factors for acute hepatitis C have been evaluated in Italy. The association between hepatitis C and the potential risk factors (odds ratios, OR) was estimated using hepatitis A patients as controls. The independent roles of the different risk factors were estimated by multiple logistic regression analysis. The incidence of non-A, non-B acute hepatitis declined from 5 per 100 000 to 1 per 100 000 between 1985 and 1996. Anti-HCV data collected by SEIEVA since 1991 showed that 60% of patients with non-A, non-B acute hepatitis were positive for antibodies to the hepatitis C virus (anti-HCV) at the time of hospitalization. During the 6 months prior to the disease onset, the most frequently reported risk factors were multiple sexual partners, other parenteral exposure and intravenous drug use; transmission by blood transfusion declined from 20% in 1985 to 2% in 1996. On multivariate analysis, intravenous drug use (OR=35.5; 95% CI=23.1–54.4), surgical intervention (OR=4.6; 95% CI=3.3–6.5), dental treatment (OR=1.5; 95% CI=1.1–1.9) and two or more sexual partners (OR=2.2; 95% CI=1.6–3.0) were all independent predictors of hepatitis C. These findings indicate that HCV infection is decreasing in Italy. Intravenous drug use, multiple sexual partners, surgical intervention and dental therapy are the main modes of transmission.     

Effect of erythropoietin therapy in cardiac surgery using autologous blood transfusion

Autologous blood transfusion in cardiac surgery is currently widely practiced to avoid homologous blood transfusion. To assess the benefit of recombinant human erythropoietin (rhEPO), the authors studied 72 patients (53 men, 19 women) who underwent elective cardiac surgery over a 15-month period and agreed to this protocol. Of these, 47 had coronary artery bypass grafting, 19 had valve replacement, and 6 had other procedures. Each patient was scheduled to preserve more than 800 mL of autologous blood preoperatively. They received rhEPO (100 to 40 U/kg) IV 3 times weekly during a 2 to 3-week preoperative period. During surgery, an autotransfusion system was also applied. During the preoperative period, 49 patients (68.1%) increased their hemoglobin by more than 1.0 g/dL, and 66 patients (91.7%) had their operation without homologous blood transfusion. This is a significantly high incidence compared with the group who had neither preoperative preservation nor rhEPO (55 of 109 patients; 50.5%). The authors conclude that rhEPO is effective in preserving autologous blood safely before elective surgery, and most elective cardiac surgery can be done without homologous blood transfusion by preoperatively preserving autologous blood with the aid of rhEPO and employing intraoperative autotransfusion.     

Autologous Blood Donation in Nonorthopaedic Surgical Procedures as a Blood Conservation Strategy

Autologous blood donation in many nonorthopaedic procedures is controversial. Our study of 408 consecutive such procedures could be divided into two groups. In group I, the anticipated probability for homologous blood transfusion was very low (less than 5%): vaginal hysterectomy and miscellaneous gynecologic procedures, obstetrical delivery, mammoplasty and cholecystectomy. In group II, the anticipated probability for homologous blood transfusion was high (greater than 5%): open heart and vascular surgery, neurosurgery, mastectomy, abdominal and radical hysterectomy, and extensive urologic procedures. We conclude that for procedures in which the blood transfusion probability is very low, autologous blood donation should not be encouraged; this practice should be promoted in procedures in which the blood transfusion probability is 'high' (i.e. greater than 5%), with emphasis on maximizing autologous blood collection in order to minimize homologous blood transfusion.     

Cardiac arrest after autologous marrow infusion

A 27-year-old woman undergoing autologous bone marrow transplantation for relapsed, refractory Hodgkin's disease developed acute non-cardiogenic pulmonary edema immediately after transfusion of autologous bone marrow. A few similar cases in the literature are identified. Although the precise mechanisms for these rare reactions are not clear, several possibilities including anaphylaxis due to dimethylsulfoxide, leukoagglutination, complement activation, and transient left ventricular dysfunction are proposed and discussed. Features which might allow patients at risk for similar events to be identified include the presence of active pulmonary tumor, and a history of dyspnea and pulmonary infiltrates following transfusion of homologous blood products.     

Patterns of Autologous Blood Use in Elective Orthopedic Surgery: Does the Availability of Autologous Blood Change Transfusion Behavior?

We studied the orthopedic surgery service at our institution to determine whether the mere availability of autologous blood (AB) affected transfusion practice. As a group, patients who had AB available received an average of 1.11 fewer red cell units per hospitalization than did patients with only homologous blood (HB) available. At every transfusion episode, those patients having AB available received fewer red cell units than did patients without AB available. Predeposit of autologous red cells was effective in protecting 77.6% of patients from HB exposure. The availability of autologous red cells resulted in an overall more conservative approach to transfusion.