Efficacy, safety and user-friendliness of two devices for postoperative autologous shed red blood cell re-infusion in elective orthopaedic surgery patients: A randomized pilot study

To determine the safety, efficacy and user-friendliness of two different postoperative autologous blood re-infusion systems, an open, randomized, controlled study was performed. Eligible consecutive primary and revision total hip and knee replacement patients were randomized for one of the two systems or for a control group in which shed blood was not re-infused. The nursing staff scored user-friendliness. Patients were monitored after re-infusion. In all three patient groups, a restrictive transfusion trigger was used. Sixty-nine of 70 randomized patients were evaluated. Ease of use, efficacy and safety of both re-infusion systems were comparable. There was no difference in allogeneic blood use between the groups. Thirty per cent of the patients re-infused with autologous blood developed a mainly mild, febrile transfusion reaction. No other adverse reactions were seen. Signs of coagulopathy after re-infusion were not found. In multivariate analysis, autologous re-infusion was an independent factor associated with a shorter hospital stay. Both postoperative autologous blood re-infusion systems were of equal efficacy and safety. The contribution of autologous wound blood re-infusion to reduce allogeneic transfusions must be investigated in a larger study.     

Characterization of immune system alterations following preoperative autologous blood donation for elective hip replacement surgery

summary .  Preoperative autologous blood donation (PABD) has been shown to decrease natural killer (NK) cell function in cancer patients, raising concerns about an increased cancer recurrence risk owing to PABD. It is unclear whether PABD leads to other immunomodulatory effects that might affect more short-term risks like postoperative infectious complications in surgical patients. Lymphocyte subsets (CD4+ T cells, CD8+ T cells, B cells, NK cells) were determined in 86 consecutive patients donating 2 units of autologous whole blood prior to elective hip replacement surgery. In addition, cytokine secretion patterns of monocytes [tumour necrosis factor (TNF)] and lymphocytes [interferon-γ, interleukin (IL)-2, IL-4, IL-10] upon stimulation were determined in a random subgroup of 58 patients. Analyses were performed immediately before the first donation and on the day prior to operation. Granulocytes increased during PABD by 4·6% ( P < 0·01). Lymphocytes decreased by 8·8% ( P < 0·01), accompanied by a relative rise in CD4+ T cells by 10·7% ( P < 0·01) and in B cells by 10·3% ( P < 0·01), and a fall of NK cells by 20·8% ( P < 0·01). Stimulated TNF secretion of monocytes was suppressed (−12·3%, P < 0·01). The effect on the reactivity of lymphocytes and the T helper 1 (Th1)/Th2 balance were variable. The observed changes of innate and cellular immunity might influence the risk of perioperative infectious complications.     

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.     

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.     

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.     

113名地中海贫血患者输注2629袋红细胞情况分析

目的掌握"地贫之家"患者的用血规律,为开展"地贫之家"的医院提供参考。方法对本院2016年6月开设"地贫之家"起至2019年5月的113名地中海贫血患者的2 629袋红细胞输注情况进行回顾性分析。结果 "地贫之家"患者ABO血型分布与所在的华南地区ABO血型分布大致相当。患者中位数年龄为9岁(6,15),93.8%(106/113)为30周岁以下,尤其以儿童及青少年为主。总体用血量逐渐增加,每年1月至2月和7月至8月的寒暑假回落,主要集中在非工作日输注。结论新建"地贫之家"用血有一定规律,输血科可参考患者的血型分布、用血周期变化制定储血计划,安排人力资源,合理安全使用血液资源。     

A study of an educational intervention to decrease inappropriate preoperative autologous blood donation: its effectiveness and the effect on subsequent transfusion rates in elective hysterectomy

BACKGROUND: Decreasing the overcollection of preoperative autologous blood is difficult to achieve. The purpose of this study was to determine whether an educational intervention designed to outline the risks of preoperative autologous collection can decrease such donations and, if so, to determine how this decrease will affect subsequent transfusion rates. STUDY DESIGN AND METHODS: An educational intervention consisting of a didactic presentation to the Department of Gynecology staff about the risks and benefits of autologous blood was implemented. Written material with similar information was given to patients. Subsequently, the percentage of patients donating autologous blood, the number of autologous units donated, and the rates of transfusion in patients eligible for autologous donation who were admitted for elective abdominal or vaginal hysterectomy were measured. These rates were compared to those in similar patients admitted in the 2 years before the educational intervention. RESULTS: After an educational intervention, the proportion of patients donating autologous blood decreased from 53 percent to 26 percent (p<0.01), and the number of units collected per patient decreased from 0.86 to 0.31 (p<0.01); this resulted in a savings of 80 autologous donations per year. Despite no difference in estimated blood loss (p = 0.46), the overall transfusion rate decreased from 10 percent to 3.7 percent (p = 0.03), while the allogeneic transfusion rate demonstrated no significant change (1.1% vs. 2.2%; p = 0.40). CONCLUSIONS: Unnecessary preoperative autologous donations by elective hysterectomy patients can be decreased by educating physicians and patients about the risks of preoperative autologous blood donation. Decreasing such unnecessary donations can decrease the subsequent autologous transfusion rate, with its attendant risks, without increasing the risk of allogeneic transfusion.     

血液回收自体输血用于肿瘤大手术的研究进展

术中血液回收自体输血现已成为"血液保护"的重要措施之一,但其在肿瘤手术中的应用一直存在争议。主要担忧在于引起肿瘤细胞的播散。我们从肿瘤细胞清除能力及肿瘤复发和转移的临床研究等方面,对血液回收自体输血在肿瘤大手术中应用的安全性进行了探讨,并对其适用范围提出建议。总之,目前研究提示,血液回收自体输血可以安全用于某些肿瘤手术,其合理的术前评估系统有待进一步建立。     

自体血回输对心瓣膜置换手术患者血栓弹力图和纤溶指标的影响

目的:探讨体外循环(extracorporeal circulation,ECC)自体血回输对心脏瓣膜置换手术患者血栓弹力图(thrombelastogram,TEG)、纤溶指标的影响。方法:选取2016年7月至2017年12月在南阳市中心医院接受ECC自体血回输对心脏瓣膜置换手术患者63例,其中研究组30例患者采用自体血回输技术、对照组33例患者采用库存血输血;对比两组患者手术前后的血红蛋白(Hb)、红细胞压积(hematocrit,Hct)、血小板(platelet,PLT)、凝血酶原时间(prothrombin time,PT)、凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原降解产物(fibrinogen degradation product,FDP)、D-二聚体(D-D)、前列腺素E2(PGE2)、血小板α-颗粒膜蛋白(GM-140)及TEG参数的变化。结果:术前,两组患者的Hb,Hct测定值差异无统计学意义(P>0.05);术后24 h,研究组患者的Hb,Hct测定值显著高于对照组(P<0.05);术前,两组患者的PLT,PT,APTT,TT水平差异无统计学意义(P>0.05);术后24 h,研究组患者的PT,APTT测定值显著低于对照组(P<0.05);术前,两组患者的FDP,D-D,PGE2,GM-140测定值差异无统计学意义(P>0.05);术后24 h,研究组患者的FDP,D-D,PGE2,GM-140测定值显著低于对照组(P<0.05);术前,两组患者的R值、K值、MA值、α角差异无统计学意义(P>0.05);术后24 h,研究组患者的R值、K值显著低于对照组(P<0.05),研究组患者的MA值、α角显著高于对照组(P<0.05)。结论:ECC自体血回输对心脏瓣膜置换手术患者的凝血功能、TEG参数及纤溶系统稳定性影响更小。     

自体血液回输在血管外科手术中的应用

目的观察自体血液回输在血管外科手术中的应用效果。方法2003年2月~2006年6月在24例血管外科手术中使用自体血液回输,记录术野出血量及回输血液量。结果24例血管外科手术平均每例回收术野出血(2245±358)m l(600~4700m l),经处理后回输浓缩红细胞平均每例(760±310)m l(410~1920m l)。全组病人术后恢复顺利,无并发症。结论术中自体血液回输能有效减少血管外科手术中血液的丢失,维持有效循环,为术者彻底行血管外科手术创造条件。     

In vitro characteristics of red blood cell concentrates prepared from under- and overcollected units of whole blood and from a paediatric blood bag system

The problem of how to deal with red blood cell concentrates (RBCs) prepared from under- or overcollected units of whole blood (WB) and how to collect blood from underweight persons arises in the context of autologous predeposit. To determine the quality of RBCs stored in PAGGS-M additive solution prepared from under- and overcollected units of whole blood and of PAGGS-M RBCs prepared from a paediatric 250-mL top outlet blood bag system we measured blood picture, haemolysis, K+, pH, ATP and 2,3-DPG on days 0, 10, 20, 30, 40 and 49 of storage. The volume of WB collected ranged from 150 to 600 mL in 50-mL increments (4 units per volume). Haemolysis was under 0.8% on day 49 in all RBCs prepared from WB donations between 200 mL and 600 mL. However, the day 49 haemolysis level of standard RBCs prepared from 450 mL of WB (0.15 +/- 0.03%) was reached earlier in RBCs from under- and overcollected units of whole blood. 2,3-DPG levels decreased rapidly between days 10 and 20 in all RBCs studied. RBCs from 450-mL donations showed acceptable ATP maintenance after 49 days (70.4% of day 0 value), while all other RBC ATP levels were below 50% of the day 0 level on day 49. In vitro quality data of RBCs prepared from a 250-mL donation in the paediatric blood bag system after storage for about 25 days were comparable to those after 49 days of storage of standard RBCs. Our results suggest that it is feasible to transfuse PAGGS-M RBCs prepared from under- as well as overcollected units of WB in the autologous setting. However, we strongly recommend shortening the storage period of such RBCs to maintain the quality level of standard RBCs.     

腰椎后路融合手术术中自体血回输对患者的影响

目的探讨术中自体血回输对腰椎后路融合术患者术后血红蛋白变化以及住院时间的影响。方法将2002年1月-2005年12月122例行腰椎后路内固定并接受输血的患者分为实验组(66例)和对照组(56例),实验组采用术中自体血回收,对照组使用异体输血。比较2组病例的术中失血量、术后引流量、异体输血量、术后血红蛋白值和影响住院时间的因素,以及输血后并发症发生率。结果实验组患者平均输入异体血170ml,对照组患者平均输入异体血615ml,2组间有显著性差异(P<0.05);2组术后各时间点的血红蛋白值无显著性差异(P>0.05);2组患者住院时间无显著性差异(P>0.05),内固定节段数目与住院时间有显著性差异(P<0.05);实验组1例患者术后出现菌血症,对照组中4例出现输血过敏反应。结论采用自体血回输技术对患者术后血红蛋白变化及住院时间无明显影响,可以防止脊柱融合手术时因输各种异体血引发的并发症发生。     

自体血回输与急性等容量血液稀释对脊柱外科手术患者全身炎症反应的影响

目的自体血回输与急性等容量血液稀释对脊柱外科手术患者全身炎症反应的影响。方法将60例脊柱外科手术患者,随机分为对照组、自体血回输组、急性等容量血液稀释组,每组20例。对照组在术中出血多时就输入异体库存血。自体血回输组在术中联合使用自体血回收装置,血红蛋白低下时就输库存血。急性等容量血液稀释组先经外周静脉输入一定晶体液或胶体液,再经颈内静脉缓慢的抽出机体血液装入专用的含有抗凝的血袋内,经血液摇摆机不停地摇动,适当的时候输入。术前(T1)、术后2h(T2)、6h(T3)、12h(T4)及24h(T5)各时间点抽血5mL,检测白细胞(WBC)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,记录术后有无并发症。结果自体血回输组和急性等容量血液稀释组回收血WBC计数均高于T1检测结果,差异有统计学意义(P0.05);3组患者在T2～T5时间点血清IL-6、TNF-α及WBC水平与T1时间点检测结果比较显著增高,但均明显低于对照组,差异有统计学意义(P0.05);术后随访无一例并发症。结论自体血回输组和急性等容量血液稀释组可以有效降低术中及术后全身炎症反应,明显节约血资源。     

A controlled trial of intra-operative autologous transfusion in cardiothoracic surgery measuring effect on transfusion requirements and clinical outcome

We carried out a prospective, controlled trial of intra-operative autologous transfusion (IOAT) in cardiac surgery using the Haemonetics Cellsaver 4, to determine the effects on transfusion requirements and early clinical outcome. Intra-operative autologous transfusion in unselected patients resulted in a reduction in the use of red cells in patients undergoing first-time operations (IOAT median 3 units, controls median 4 units, P = 0.0023), with no difference in the use of other blood products. Post-operative haemoglobin was higher in IOAT patients (IOAT 11.6 g/dl +/- 1.1 versus controls 11.2 g/dl +/- 0.98, P < 0.001). There is therefore the potential for a further reduction in homologous blood use in the IOAT group. There was no difference in early clinical outcome in the two groups; in particular the incidence of coagulopathies was not influenced by IOAT. The routine use of IOAT would add substantially to the cost of these operations. The decision to use it must therefore be based on an assessment of the value of the reduction in risk to the patient achieved by a small reduction in homologous donor exposures.     

Survey of autologous blood transfusion activity in England (2001)

Better Blood Transfusion' (Department of Health (1998) HSC 1998/224) stressed the need for National Health Service Trusts to explore the feasibility of autologous blood transfusions and raise patient awareness of these techniques. The development of an appropriate strategy to promote autologous transfusion requires an understanding of current use, along with constraints to increasing practice. Past surveys have shown unchanging attitudes to autologous transfusion (Torrella et al. (2001) Transfusion Medicine, 11, 15-19), but detailed information regarding the extent of autologous transfusion in England and North Wales was not available. This survey, carried out in 2001, considered autologous transfusion under four headings: predeposit autologous donation, acute normovolaemic haemodilution, intra-operative cell salvage and postoperative cell salvage. Questionnaires were returned from 265/310 (85.4%) hospitals served by the National Blood Service. Sixty per cent of respondents performed at least one autologous technique, although practice was limited to a few clinicians within each hospital. Predeposit donation was the most widespread technique but involved very few patients. Intra- and postoperative cell salvage techniques were practised in fewer hospitals but on many more patients. The main constraints to increasing use of autologous techniques were perceived to be logistical, but removal of constraints may only result in small increases in individual practice. More clinicians need to be encouraged to utilize appropriate, evidence-based autologous techniques.