Feasibility and success of a single-donor red cell program for pediatric elective surgery patients

Although the risks of allogeneic blood transfusions are small, it is wise to limit donor exposure whenever possible. A program has been developed in which one donor provided all red cell (RBC) units for each patient awaiting elective surgery. Patients were mostly children who were ineligible for autologous blood donation. Seventy-three patients and 115 donors (mostly parents) entered the program. Of the 115 donors, 90 (78%) were eligible to participate and 25 (22%) were ineligible; 21 were ineligible because of RBC incompatibility. For each of the 73 patients, one eligible donor was selected to donate all RBC units. Preoperative RBC orders were 1 to 2 units for 41 patients and > or = 3 units for 32 patients. Of the 73 donors, 58 (79%) gave all RBC units ordered; 15 (21%) failed to complete all donations, but only 1 because of anemia (hematocrit < 33% [0.33]). Of 73 patients entered, 46 (63%) underwent transfusion, and 27 (37%) did not. Of 46 patients transfused, 38 (83%) received only single-donor RBCs. Thus, the RBC needs of nearly all pediatric elective surgery patients were provided by a single donor for each patient. Single-donor blood programs should be considered for elective surgery patients who are ineligible for autologous blood donation and who would otherwise be exposed to multiple donors.     

Massive transfusion during major surgery in a child with anti-Knopsa and one kidney

Massive transfusion has been defined as the replacement of one-third to one-half of the blood volume of the patient. It usually implies the presence of shock and is associated with multiple traumatic injuries. Blood replacement is almost always banked blood given in large quantities. However, massive transfusion with autologous blood can also be applied to elective cases and is becoming a useful and clinically beneficial service both in the quality of the products transfused service both in the quality of the products transfused and avoidance of diseases transmitted by blood transfusion from heterologous blood donor sources. Operations which regularly require the transfusion of three or more units of blood include open heart surgery, orthopedic reconstructive procedures, vascular surgery and abdominal surgical procedures. The case presented here, an orthopedic procedure, describes an example of elective massive transfusion, successfully performed in the presence of a rare alloantibody to red blood cells.     

Discharge haematocrit as clinical indicator for blood transfusion audit in surgery patients

SUMMARY. Three cohorts of elective surgical patients were reviewed in order to develop a method in which the discharge haematocrit can serve as a clinical indicator for a subsequent study of the use of blood transfusion therapy. Three different levels of discharge haematocrit were evaluated: 36, 33, and 30% for ‘generous’, ‘intermediate’, and ‘strict’ criteria, respectively. Discharge haematocrits (%, mean ± SD) for patients not transfused were 29.6±4.6, 33.7 ± 5.0, and 33.6 ± 3.4 for three different surgical groups (cardiac, orthopaedic, and urological surgical patients). When discharge haematocrits greater than 33% (‘intermediate’) were considered excessive due to previous transfusion, the prevalence of patients identified was 9, 6.5 and 13%, respectively. We found no relationship between the length of stay in hospital and the number of blood units transfused or patient discharge haematocrit levels. When the length of stay of patients identified by exceeding the clinical indicator was compared to that of patients not identified, orthopaedic and urological surgical patients showed no difference; however, cardiac surgical patients who exceeded the clinical indicator had shorter hospital stays compared to patients who were not so identified. We conclude the following: 1 The discharge haematocrit can be used as a clinical indicator for a subsequent review of use in order to evaluate the appropriateness of blood transfusion therapy. 2 The prevalence of patients identified who exceeded the clinical indicator, among three elective surgical patient groups, suggests that this indicator is applicable across elective surgical categories in order to target transfusion medicine education programmes and clinical outcome studies. 3 Additional factors important to the ‘transfusion trigger’, such as blood lost during hospitalization, may need to be included with the discharge haematocrit as clinical indicators in order to evaluate blood transfusion therapy in this setting.     

Preoperative autologous blood donation: benefit or detriment? A mathematical analysis

BACKGROUND: Advocates of preoperative autologous blood donation (PABD) often fail to consider the needs of individual patients and the effects of donation on hematocrit. Mathematical modeling is used here to analyze PABD. STUDY DESIGN AND METHODS: A model of PABD was constructed to simulate the transfusion of red cells once a predetermined minimum hematocrit was reached. Preoperatively deposited units not needed to maintain a hematocrit at this level were not transfused. Final hematocrits were compared to the hematocrit that would be expected if the patient had not donated blood for his or her own operative use. RESULTS: For many patients, particularly those with normal initial hematocrits, large estimated blood losses must occur before the minimum hematocrit is reached. It is also known that patients donating multiple units typically cannot maintain their baseline hematocrit. In such cases, for blood losses of any volume, the final hematocrit was lower if units were collected preoperatively and transfusion did not occur. Preoperatively donating patients are more likely to be transfused earlier and more frequently than nondonating patients. Derived figures, based on individual patient values, help predict which patients will benefit most from PABD. CONCLUSION: PABD may actually lead to decreased postoperative hematocritis (with enhanced risk of ischemia) and otherwise unnecessary transfusions.     

Efficacy of preoperative donation of blood for autologous use in radical prostatectomy

To determine the amount of blood lost, the number of transfusions, and the effectiveness of preoperative autologous blood donation in radical prostatectomy, 163 patients' records from 1987 to 1991 were reviewed at four university hospitals and three community hospitals. Calculated red cell volume lost was 1003 +/− 535 mL (mean +/− SD), which corresponds to 44 +/− 18 percent (mean +/− SD) of total red cell volume. Preoperative donation of blood for autologous use reduced the rate of transfusion of allogeneic blood from 66 to 20 percent (p < 0.001). Of the patients who donated 1 to 2 units, 32 percent received allogeneic blood; 14 percent of those who donated 3 units received allogeneic blood. Donation of 4 units reduced the allogeneic transfusion rate to 11 percent. However, as the number of units donated increased (1-3 units), the units not transfused also increased (0-21%). Ninety-one (56%) of 163 patients donated fewer than 3 units. Autologous blood donation is effective in minimizing the transfusion of allogeneic blood to radical prostatectomy patients, but many patients do not donate enough blood (< 3 units). The donation of 3 units of blood for autologous use is recommended for patients who undergo radical prostatectomy.     

Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty

BACKGROUND: This study was designed to obtain data on the incidence of postoperative infection in patients undergoing elective orthopedic surgery and receiving white blood cell (WBC)-filtered blood components prepared according to current standards. STUDY DESIGN AND METHODS: A total of 308 consecutive orthopedic patients who opted for preoperative autologous blood donation (PAD) for primary unilateral hip and knee replacement surgery were enrolled in a prospective observational study of the incidence of postoperative infection. Patients with contraindications for PAD or with any infectious disease were not included in the study. To identify probably confounding factors, differences between patient groups were analyzed first. Identified factors, which differed between groups, and variables describing blood supply were further tested in uni- and multivariate logistic regression analysis for their independent influence on development of postoperative infection. Infection rates were compared on the basis of actual transfusion groups. RESULTS: Of the 308 study patients, 101 were not transfused, 85 received their PAD, 100 received allogeneic WBC-filtered red blood cells (RBCs), and 22 were given autologous RBCs and additionally allogeneic WBC-filtered RBCs. Overall the infection rate was 6.82 percent (21/308). Infection rates varied significantly between transfusion groups (no transfusion, 6.9%; autologous RBCs, 1.2%; allogeneic WBC-filtered RBCs, 12.0%; both transfusion types, 4.6%; p = 0.03). Allogeneic recipients showed significantly more infections compared to autologous recipients (p = 0.0053). Multivariate regression analysis confirmed transfusion of allogeneic WBC-filtered RBCs as an independent variable predicting postoperative infection (odds ratio, 23.65; confidence interval, 1.3-422.1; p = 0.01). CONCLUSION: Differences in postoperative infection rates between allogeneic and autologous recipients are still observable, although universal WBC filtration has been introduced into clinical practice.     

输血支持在造血干细胞移植中的应用

背景:接受造血干细胞移植的患者经常需要血液制品输注支持,而患者对红细胞和血小板输注的需求差异非常大,这主要依赖于造血干细胞移植的类型和患者本身的疾病性质。目的:评价中山大学附属中山医院接受造血干细胞移植患者移植期间输血的需求和数量。方法:收集中山大学附属中山医院2004-01/2010-06接受造血干细胞移植患者的资料,包括移植的适应证、移植的类型、CD34+细胞的数量、红细胞和血小板的输注数量、费用、脱离输注时间以及中性粒细胞和血小板植入时间;红细胞输注的阈值是血红蛋白计数为70g/L,而血小板的输注阈值是计数为20×109L-1。研究分析了患者移植期间红细胞和血小板输注的需求、输注量、输血费用,以及患者的生存情况。结果与结论:自体造血干细胞移植组中有14例(93%)患者,而异基因造血干细胞移植组中有35例(90%)患者显示了造血细胞植入和脱离输注证据。自体造血干细胞移植组取得脱离红细胞输注天数为14.6d,明显短于异基因造血干细胞移植组。与异基因造血干细胞移植组比较,自体造血干细胞移植组红细胞输注单位明显减少;而异基因造血干细胞移植组的红细胞输注费用明显高于自体造血干细胞移植组。输血花费昂贵,但却是造血干细胞移植中必不可少的一部分,异基因造血干细胞移植组需要更多的输血支持。脱离输注时间有望成为评估造血干细胞移植成功的指标。     

AUTOLOGOUS BLOOD TRANSFUSION TODAY

Autologous blood transfusion — the transfusion to a patient of his or her own blood — is increasingly being recognised as a useful adjunct to traditional transfusion practice. The reasons include fears of disease transmission, the potential adverse effects on the recipient's immune system of transfused donor blood, and logistical factors. The three main techniques of autologous transfusion are: (i) pre-deposit, in which patients donate blood over a period of time in preparation for elective surgery; (ii) pre-operative isovolaemic haemodilution, in which blood is removed immediately before surgery and volume replacement is given, the blood being reinfused post-operatively; and (iii) salvage transfusion – the collection of blood shed at surgery or in similar circumstances, which is reinfused immediately or after concentration and purification. All three techniques can help to improve the safety of transfusion and economise on scarce supplies of donor blood.     

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.     

Utilization and effectiveness of a hospital autologous preoperative blood donor program

The utilization and effectiveness of a hospital preoperative autologous blood donation program were analyzed. Over 16 months, 180 donors, or 11.6 percent of eligible patients (those undergoing elective surgical procedures where blood was routinely crossmatched), were enrolled in the program. They donated an average of 2.2 units of red cells, or 59 percent of the mean order of 3.7 units. Donations were completed in 17.9 days, leaving 10.7 days between the last donation and hospitalization. Of all scheduled donations, 25.5 percent were cancelled due to deferrals; 47.8 percent of patients were deferred at least once. Most patients were able to donate a unit of blood weekly, with minimal drops in hematocrit (mean 3.2%). The reaction rate, 4.8 percent, was comparable to figures reported for homologous donors. Nearly two-thirds of participants used no homologous blood during their hospitalization: 28.6 percent used no blood whatsoever, and 36.9 percent used only autologous components. Including released autologous components subsequently administered to other recipients, transfused autologous red cells were 2.1 percent and fresh-frozen plasma (FFP) 7.2 percent of the hospital's blood supply. Although the high deferral rate complicated the administration of the program, this complication was offset by the demonstration of donor safety, reduction in the proportion of patients who used homologous blood, and the contribution of autologous blood components to the hospital's blood inventory.     

The effect of recombinant human erythropoietin on the efficacy of autologous blood donation in patients with low hematocrits: a multicenter, randomized, double-blind, controlled trial

BACKGROUND: This randomized controlled study was undertaken to determine the effect of recombinant human erythropoietin (rHuEPO) on erythropoiesis, autologous blood collection, and allogeneic transfusion risk in elective surgery patients with low baseline hematocrits. STUDY DESIGN AND METHODS: Patients (n = 204) with low baseline hematocrits ( < or = 39%), scheduled for orthopedic surgery within 25 to 35 days, were seen every 3 to 4 days for 21 days. At each visit, 450 mL of blood was collected if the hematocrit was > or = 33 percent, and rHuEPO (600 U/kg) or placebo was administered intravenously. RESULTS: One hundred seventy-three patients were evaluable. The number of autologous units collected from the rHuEPO and control groups, respectively, was 4.5 +/− 1.0 and 3.0 +/− 1.1 (p < 0.001), and marrow production of red cells increased by 668 +/− 222 and 353 +/− 155 mL over and above baseline production (p < 0.05). Allogeneic blood transfusion was required by 31 percent of control and 20 percent of rHuEPO patients (p = 0.09). Excluding 8 patients who received > 6 units, 29 percent of control and 14 percent of rHuEPO patients required allogeneic blood (p = 0.015). Logistic regression modeling determined that the risk of allogeneic transfusion was reduced by rHuEPO (p = 0.025). CONCLUSION: The use of rHuEPO stimulates erythropoiesis, permits the storage of more autologous blood, and reduces allogeneic transfusion risk in patients with low hematocrits who are undergoing elective orthopedic surgery. Additional studies are necessary to determine the optimal schedules of rHuEPO administration and autologous blood collection as well as the cost-effectiveness of this strategy.     

Autologous blood transfusion today.

Autologous blood transfusion--the transfusion to a patient of his or her own blood--is increasingly being recognised as a useful adjunct to traditional transfusion practice. The reasons include fears of disease transmission, the potential adverse effects on the recipient's immune system of transfused donor blood, and logistical factors. The three main techniques of autologous transfusion are: (i) pre-deposit, in which patients donate blood over a period of time in preparation for elective surgery; (ii) pre-operative isovolaemic haemodilution, in which blood is removed immediately before surgery and volume replacement is given, the blood being reinfused post-operatively; and (iii) salvage transfusion--the collection of blood shed at surgery or in similar circumstances, which is reinfused immediately or after concentration and purification. All three techniques can help to improve the safety of transfusion and economise on scarce supplies of donor blood.     

Simplified enrollment for autologous transfusion: automatic referral of presurgical patients for assessment for autologous blood collections.

We implemented a pilot program at our institution for automatic referral of patients for presurgical assessment for preoperative and intraoperative collection of autologous blood. Although patients and clinicians support the use of autologous transfusion, often a request for collection of autologous blood is not initiated. During 11 months, 269 patients (82%) of three orthopedic surgeons entered the program, and 218 underwent operation and were dismissed from the hospital. A total of 940 units of autologous blood (675 preoperatively and 265 intraoperatively) was collected from these 218 patients, and 84% of the units were transfused. Throughout hospitalization, 86% of the patients received only autologous blood, whereas 14% received various proportions of homologous and autologous blood. In contrast, only 26% of a concomitant control group of 220 consecutive orthopedic surgical patients not participating in the automatic-referral program received only autologous blood. Thus, the automatic-referral program increased the percentage of elective orthopedic surgical patients who received only autologous blood from 26% to 86% (P less than 0.001). This study also showed that the same amount of blood was used for autologous transfusions as was routinely used for homologous transfusions in similar cases. The automatic-referral system was convenient for physicians and patients and offered the benefits of reduction of transfusion-associated risks and amelioration of patient anxieties.     

输血支持在造血干细胞移植中的应用

背景：接受造血干细胞移植的患者经常需要血液制品输注支持,而患者对红细胞和血小板输注的需求差异非常大,这主要依赖于造血干细胞移植的类型和患者本身的疾病性质。目的：评价中山大学附属中山医院接受造血干细胞移植患者移植期间输血的需求和数量。方法：收集中山大学附属中山医院2004-01/2010-06接受造血干细胞移植患者的资料,包括移植的适应证、移植的类型、CD34＋细胞的数量、红细胞和血小板的输注数量、费用、脱离输注时间以及中性粒细胞和血小板植入时间;红细胞输注的阈值是血红蛋白计数为70g/L,而血小板的输注阈值是计数为20×109L-1。研究分析了患者移植期间红细胞和血小板输注的需求、输注量、输血费用,以及患者的生存情况。结果与结论：自体造血干细胞移植组中有14例（93%）患者,而异基因造血干细胞移植组中有35例（90%）患者显示了造血细胞植入和脱离输注证据。自体造血干细胞移植组取得脱离红细胞输注天数为14.6d,明显短于异基因造血干细胞移植组。与异基因造血干细胞移植组比较,自体造血干细胞移植组红细胞输注单位明显减少;而异基因造血干细胞移植组的红细胞输注费用明显高于自体造血干细胞移植组。输血花费昂贵,但却是造血干细胞移植中必不可少的一部分,异基因造血干细胞移植组需要更多的输血支持。脱离输注时间有望成为评估造血干细胞移植成功的指标。     

自体血液回收术在肝移植中的应用

目的 观察肝移植术中应用自体血液回收技术的安全性和效果。方法 对9例原位肝移植患者术中应用Cell Saver5型血液回收机进行自体输血。记录术前、术后1d红细胞计数（RBC）、血红蛋白（Hb）、血球压积（HCT）、血小板（PLT）、凝血酶原时间（PT）和部分活化凝血活酶时间（APTT）,术中根据血常规及凝血功能检查结果及时补充各种血液成分和鱼精蛋白。同时记录术中出血量、回收血量及回输浓缩红细胞量。结果 术中平均每例出血9145ml,平均每例回收血量6688ml,平均每例回输浓缩红细胞量3651ml。术中所有患者血流动力学稳定,仅术后24h血小板计数略低于术前,但差异无显著性（P〉0．05）。结论 肝移植术中采用自体血液回输技术,可为患者及时提供浓缩红细胞,避免大量异体血输入,确保输血安全。     

Experience with autologous bone marrow harvesting and transfusion of marrow-derived red cells

Marrow red cells (MRBCs) from 56 autologous bone marrow harvests were rescued after processing and transfused as the sole transfusion support after surgery. There was no correlation between volume of harvest and total mononuclear cell (MNC) count. The marrow collection induced a significant decrease in hematocrit values (mean, 6.1; range, -0.3-12.3; p less than 0.001) unrelated to the patient's diagnosis, age, or gender. Processing of the marrows resulted in a mean transfused MRBC mass of 258 mL (range, 101-494 mL), representing 78 percent (range, 43-100%) of the MRBC mass collected. The amount of MRBCs transfused correlated with total MNC count (p less than 0.01). All autologous MRBC transfusions were well tolerated. It can be concluded that autologous MRBC transfusions are safe and may eliminate the need for homologous blood transfusions after marrow harvest.     

34例异位妊娠破裂伴失血性休克术中自体血回输的临床应用

目的：探讨自体血回输在异位妊娠破裂伴失血性休克术中的临床应用价值。方法：我院2010-05-2012-05采用自体血液回输机对34例异位妊娠破裂伴失血性休克患者在术中进行自体血回输,分别记录术中出血量和回输血量。结果：34例患者共回收自体血52940ml,回输血32130ml,所有患者术后恢复良好,无相关并发症。结论：异位妊娠破裂伴失血性休克术中运用自体血回输安全,可快速获得新鲜红细胞,有效维持血容量,减少异体血的使用,降低输血并发症,提高抢救成功率。     

综合、全程血液管理措施对骨科手术患者异体输血的影响

  目的  回顾分析综合、全程血液管理措施对骨科手术患者异体输血情况的影响。  方法  纳入北京协和医院骨科2013年1月至2014年12月接受骨科手术的7082例患者, 其中2013年3320例, 2014年3762例; 高出血风险手术2013年2178例, 2014年2322例。2014年1月起, 骨科开始全面采取涉及全围术期的自体输血技术、改进手术及围术期治疗技术、药物干预和科学执行输血原则四方面的个体化综合血液管理措施。将2014年异体输血情况与2013年情况进行回顾性比较, 评估新措施对骨科手术患者异体输血的影响。  结果  2013、2014两年度患者性别、年龄、高出血风险手术类型及分布情况类似。2014年总手术量及高出血风险手术量均大于2013年度。2014年所有患者异体总输血量106 950 ml(713例)低于2013年121 600 ml(760例), 异体总输入浓缩红细胞单位数2543 U低于2013年2804 U。2014年异体输血总花费680 720元, 占异体输血患者医疗总费用比例0.97%(680 720元/70 287 242.03元), 占总医疗费用0.35%(680 720元/196 100 485元)均低于2013年(分别为1.04%和0.42%)。2014年平均住院日(12.46 d比12.90 d)和并发症发生率(2.02%比5.03%)均低于2013年。  结论  通过执行全面、科学的综合血液管理措施, 可以在保障患者医疗安全、保持高效医疗服务能力的同时, 减少骨科手术患者的异体输血量。     

Safety and efficacy of unmodified whole blood vs. buffy coat-depleted red cell concentrates in autologous transfusion of elective orthopaedic surgery patients

Storing autologous blood as whole blood (WB) has been proposed for increasing the cost-effectiveness of preoperative autologous blood donation programmes. However, experimental data suggest that autologous leucocytes might lead to immunomodulation similar to the effect attributed to allogeneic leucocytes. In a retrospective analysis, the postoperative outcome of 120 patients undergoing elective orthopaedic surgery and having donated up to two units of autologous WB (AWB) was compared with that of a control group of 52 patients, whose autologous donation had been processed into buffy coat-depleted red cell concentrates (RCC). At least one autologous unit, but no allogeneic units, had been transfused in all analysed patients. Donation schemes were equally efficacious in both groups. There was no significant difference in postoperative infection rates between the two groups. Overall rates were 7.7% in the RCC group and 8.3% in the WB group. Surgical, thromboembolic and other recorded complications, length of postoperative hospital stay and days of the use of antibiotics were also not significantly different between the two groups. The results of this study suggest that transfusion of up to two units of unmodified AWB is as efficacious as the transfusion of autologous RCC and does not negatively influence the postoperative outcome in elective orthopaedic surgery.     

Red cell loss following orthopedic surgery: the case against postoperative blood salvage

BACKGROUND: Expensive devices have been developed for the collection and transfusion of blood salvaged after hip or knee arthroplasty. STUDY DESIGN AND METHODS: The volume of salvaged red cells was measured for the first 6 hours after operation. This volume was compared to total red cell loss during hospitalization and to the volume of allogeneic red cells transfused. RESULTS: Mean postoperative red cell loss in 31 patients following hip replacement was 55 +/− 29 mL and that in 20 patients following knee replacement was 121 +/− 50 mL. The 6-hour wound drainage represented 8.7 and 16.8 percent of overall red cell loss during hospitalization for hip and knee replacement, respectively. The transfusion of postoperatively salvaged red cells would have supplanted transfusion of less than one-third of a unit of allogenic blood after hip replacement and two-thirds of a unit after knee replacement. Only three patients (5.9%) lost red cell volume in the drainage equivalent to or in excess of 1 unit of red cells (180 mL). The volume of red cells salvaged postoperatively bore no relationship to perioperative red cell losses as a whole. CONCLUSION: The relatively small red cell loss in the postoperative period in most arthroplasty patients does not appear to justify the routine use of this technique for the recovery of autologous blood.