Preoperative autologous blood donation by elderly patients undergoing orthopaedic surgery.
Gandini G,Franchini M,de Gironcoli M,Giuffrida A,Bertuzzo D,Zanolla L,Ferro I,Regis D,Aprili G
BACKGROUND AND OBJECTIVES:To assess the feasibility of a programme of predeposit in elderly patients undergoing elective orthopaedic surgery. PATIENTS AND METHODS:We retrospectively studied 789 elderly patient candidates (> 65 years of age) for orthopaedic surgery (total hip and knee replacement and spinal surgery), who were undergoing a programme of preoperative autologous blood donation (PABD) in our city hospital between January 1990 and December 1998. RESULTS:Six hundred and eighty-eight patients (87.2%) were transfused with autologous blood; 128 (16.2%) also received allogeneic blood. Hip arthroplasty revision was characterized by the greatest blood consumption. The predeposit programme was discontinued in 96 patients (12.2%) because of the following complications: the onset of anaemia (11.0%); vasovagal reactions (0.5%); lack of venous access (0.4%); or cardiac complications (0.2%). No episodes of reaction to autologous transfusion were recorded. CONCLUSIONS:Our study confirms the feasibility of PABD in elderly patients undergoing elective orthopaedic surgery.
Preoperative autologous blood donation in primary total knee arthroplasty: critical review of current indications.
Regis Dario,Corallo Fabio,Franchini Massimo,Rosa Raffaella,Ricci Matteo,Bartolozzi Pietro
La Chirurgia degli organi di movimento
Preoperative autologous blood donation (PABD) is a well established transfusion practice in elective orthopaedic surgery, involving immunologic and infective advantages but also involving exposure to not negligible risks, and costs as well. The aim of this study was to assess the real need for blood transfusions in primary total knee arthroplasty (TKA). Between January 2000 and July 2005, 214 patients underwent primary unilateral TKA. Altogether, 416 autologous blood units were collected, however only 47 (11.3%) were transfused. Thirty-eight patients (17.8%) received autologous blood, while 4 of them (10.5%) also received allogeneic blood. Based on the results of this study, PABD should be recommended in well selected patients undergoing TKA: older female patients with a low basal haemoglobin level.
Continuous improvement of our autologous blood donation program carried out during 10 years in 1198 orthopaedic patients.
Cabibbo Sergio,Garozzo Giovanni,Antolino Agostino,Bennardello Francesco,Calabrese Salvatore,Manenti Oriella,Assenza Giorgio,Sallemi Giorgio,Bonomo Pietro
Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis
BACKGROUND:We analysed the relationship between baseline haemoglobin levels and the need for post-operative blood transfusion in our patients. The aim of this study was to evaluate and optimize the pre-operative autologous blood donation (PABD) program at our hospital through a constant audit. MATERIALS AND METHODS:Between January 1997 and December 2006 we evaluated 1198 consecutive patients who underwent elective, unilateral, primary total hip or knee arthroplasty and who met our inclusion criteria. We determined the baseline haemoglobin level to establish the relationship to the need for post-operative transfusion. RESULTS:The results of our study show that the baseline haemoglobin level is a strong predictor of blood transfusion after unilateral, primary total hip or knee arthroplasty. CONCLUSIONS:The baseline haemoglobin level is a strong predictor of blood transfusion after elective, unilateral, primary total hip or knee arthroplasty. On the basis of these findings, we do not recommend autologous predonation for patients with a baseline haemoglobin level of >14g/dl moreover we always recommend the use of a blood cell salvage system and a constant audit of pre-operative autologous blood donation (PABD) to avoid unnecessary expense and waste.
Preoperative autologous blood donation by 1073 elderly patients undergoing elective surgery: a safe and effective practice.
Gandini G,Franchini M,Bertuzzo D,Olzer D,Crocco I,De Gironcoli M,Aprili G
BACKGROUND:Preoperative autologous blood donation (PABD) aims at avoiding the risks associated with exposure to allogeneic blood. While its use is extremely common among adult patients in connection with elective surgery, it is still uncommon in elderly patients, because of a series of coexisting pathologies. STUDY DESIGN AND METHODS:A retrospective study was made of 1073 consecutive elderly patients at a city hospital from 1990 to 1996. Their responses to the PABD program were evaluated by analysis of the incidence of complications and the demand for allogeneic blood. RESULTS:The PABD program was interrupted in 79 (7.4%) of 1073 patients because of the onset of anemia, vasovagal reactions, lack of accessible superficial veins, or cardiovascular complications. Seven hundred eighty-four (73.1%) of 1073 patients were given autologous blood; 151 (14.1%) patients also required allogeneic blood. CONCLUSION:The onset of anemia (6.5%) was the main contraindication for continuing the PABD program: incidence increased with age. PABD in connection with elective surgery is both feasible and effective in a high percentage of elderly patients.
Erythropoietin as adjuvant to pre-operative autologous blood donation in total hip arthroplasty: new algorithm for use.
Vargas-Pabon Manuel,Diaz-Trapiella Ana,Hurtado Miguel Jimenez,Diaz Varela Nicolas,Cerra Sabio Jose Luis
Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis
Erythropoietin (rhEPO) has been used in different surgical procedures as a method for saving allogeneic blood, with variable efficacy. Forty consecutive patients entered the pre-operative autologous blood donation (PABD) program, and during donations hemoglobin fell below 115 g/l; they received rhEPO 40,000 U every week for three or four weeks (group 1). As control group, 35 consecutive patients who entered the PABD program were studied; during donations, hemoglobin levels in these patients fell below 115 g/l, but rhEPO was not administered (group 2). Pre-surgery hemoglobin levels were higher in patients who received rhEPO (134 g/l vs. 121 g/l; p<0.0002), and an average of 3.47 doses were administered. The number of transfused autologous units was 1.6 in group 1 and 2.1 in group 2 (p<0.05), while the number of allogeneic units was 0.9 and 0.1, respectively (p<0.0005), so that only 5% of patients treated with rhEPO required some allogeneic unit, as compared to 40% of those who did not receive rhEPO (p<0.0005). There were no relevant adverse effects, but in two patients from group 1, rhEPO treatment had to be discontinued because the level of hemoglobin exceeded 150 g/l. The mean duration of hospital admission was shorter in the patients who received rhEPO than in those who only underwent PABD (8 days vs. 11.8 days; NS). When adequately used, rhEPO is an effective and safe alternative to the use of allogeneic blood.
A review of the application of autologous blood transfusion.
Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas
Autologous blood transfusion (ABT) has been gradually attracting more attention due to the increasingly prominent problem of blood transfusion safety and blood shortage in recent years. With the rapid development of blood conservation techniques, blood component separation technology, blood transfusion medicine and a constant increase in clinical needs, ABT technology has been expanded and innovated to a large degree. In this study, the development of preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH), intraoperative and postoperative autotransfusion, and other new technologies and theories are reviewed and existing questions are analyzed. Challenges and applications are also discussed in order to provide reference for peers.
Targeted pre-operative autologous blood donation: a prospective study of two thousand and three hundred and fifty total hip arthroplasties.
Bou Monsef Jad,Figgie Mark P,Mayman David,Boettner Friedrich
PURPOSE:Pre-operative donation of autologous blood has been widely used in elective joint replacement procedures to avoid the risks of allogeneic blood transfusions. However, the high percentage of wasted autologous blood questions the general efficacy of pre-operative autologous blood donation (PABD) for all patients undergoing hip replacement. This study prospectively investigates the impact of a targeted pre-operative autologous blood donation protocol for anaemic patients on allogeneic and overall transfusion rates in 2,350 unilateral primary total hip arthroplasty procedures. METHODS:Patients with pre-operative haemoglobin less than 12.5 g/dL were advised to donate one unit of autologous blood seven to 15 days prior to the date of surgery. The targeted protocol was followed by 2,251 patients: 280 out of 367 anaemic patients donated while 1,971 out of 1,983 non-anaemic patients did not donate. RESULTS:Results showed a significantly lower rate of allogeneic transfusion for anaemic patients who predonated than anaemic patients who did not (13 % vs. 37% respectively, p < 0.001). Overall transfusion rates for patients who followed the protocol (n = 2,251) were found to be 0.17 units/patient compared to previously reported numbers of 0.75 units/patient when routine donation was used. Among the 2,251 patients who followed the protocol, only 140 patients (6%) had their autologous blood wasted, in contrast to values reported in the literature ranging from 14% up to 50%. CONCLUSIONS:Targeted PABD reduces the need for allogeneic blood transfusion in anaemic patients and significantly reduces the overall number of transfusions compared to routine pre-operative autologous donation.
Preoperative autologous blood donation: a therapy that needs to be scientifically evaluated.
Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine
The aim of preoperative autologous blood donation (PABD) is to reduce both the risk of transfusion transmitted disease and the need of blood from donors. One advantage of PABD is to prevent transfusion-transmitted disease namely viral infections such as HIV or hepatitis virus or emerging virus. Actually, the very low residual risk of allogeneic transfusion does not argue for PABD. On the other hand, the risk of bacterial contamination must be taken in account for both autologous and homologous transfusion (HT). A meta-analysis showed that ABD reduces the exposure to HT (OR: O.17). Clinical studies evidenced that patients who predonated autologous blood were more likely to receive any blood transfusions (autologous and/or allogeneic) than those who did not (OR: 3.31). More, the reduction of exposure to allogeneic transfusion may be questioned in view of prescription bias. Additionally, PABD is poorly cost-effective. It leads to significant blood wastage while in most studies about half of the units are discarded. In conclusion PABD is a therapy that has not been sufficiently evaluated. The interest of this therapy remains to be demonstrated.
A Study of Preoperative Autologous Blood Donation Timing.
Zhou Jun,Chen Zhen,Jin Jing,Zhang Qiu-Li
Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion
This study aims to determine the safe and effective autologous blood drawing time for preoperative autologous blood donation (PABDs) by comparing the outcome of two different schedules of PABDs. A total of 144 patients who underwent elective surgery (radical resection of digestive tract tumor, lumbarspinesurgery and Intracranial tumor resection) were retrospectively reviewed. 88 patients had donated autologous blood 2 days before the operation (group 1); 56 patients had donated autologous blood more than 3 days before the operation (group 2). Hb and Hct before the operation and on postoperative days one and three, allogeneic blood transfusions, total bleeding, postoperative length of stay, and length of stay were measured and compared. Hb at postoperative day one was lower in group 2 than in group 1 ( < 0.05). Furthermore, Hb in group 1 was higher at postoperative day one than at postoperative day three ( < 0.05). Differences in postoperative Hct, allogeneic blood transfusions, total bleeding and postoperative length of stay between these two groups were not statistically significant ( > 0.05)., The difference in the average number of postoperative hospitalization days between these two groups was not statistically significant ( > 0.05). The 2 days of PABD did not lead to any adverse recovery effect. It would be helpful to conduct preoperative autologous blood transfusions.
Feasibility of pre-operative autologous blood donation in Indian patients with elective orthopaedic surgery.
Saluja Karan,Marwaha Neelam,Thakral Beenu,Goni Vijay,Sharma R R,Puri G D
The Indian journal of medical research
BACKGROUND & OBJECTIVES:Pre-operative autologous blood donation (PABD) in elective orthopaedic surgeries is a well known procedure in the West. We initiated this programme at a tertiary care hospital in north India to study its feasibility in Indian patients. METHODS:In a prospective case-control study, 144 patients undergoing primary total hip or knee replacement, inter-vertebral discectomy, mal-union and non-union reconstruction were educated and motivated to pre-donate. Patients fulfilling the inclusion criteria and making autologous donation formed the PABD group (n=22). Patients eligible for PABD, but unwilling to participate; age, sex, pre-operative haemoglobin and operative procedure matched acted as controls (n=27). Unit(s) collected was processed like an allogeneic unit. Unit(s) found reactive for infectious markers or not utilized was discarded. Mean blood losses, transfusion trigger, allogeneic exposure and wastage between the two groups were compared. RESULTS:Of the 144 patients motivated, 40 per cent of the eligible subjects pre-deposited. The main motivational factor was fear of getting infection from someone's blood. Cardiac events and anaemia prevented 61.8 per cent patients to participate. Of the 50 units ordered, autologous units with a mean of 1.4 units/patient contributed 62 per cent. For total hip and total knee replacement (THR and TKR), autologous units met 76.2 and 80 per cent respectively of the total blood requirement. A significant decrease in the allogeneic exposure was observed between PABD and control group (18.2 vs 66.7%); 32.3 per cent of the autologous units were discarded. INTERPRETATION & CONCLUSION:Comprehensive PABD programme may be an effective method for reducing the need for allogeneic transfusion in patients undergoing joint replacement surgeries in our country, where transfusion transmitted infections due to high percentage of replacement donations and lack of sensitive assays for testing are still a cause for concern.
Efficiency and safety of preoperative autologous blood donation in cardiac surgery: a matched-pair analysis in 432 patients.
Martin Klaus,Keller Emanuel,Gertler Ralph,Tassani Peter,Wiesner Gunther
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
OBJECTIVE:A shortage of blood products is predicted for the near future in many countries all over the world. Preoperative autologous blood donation (PABD) in cardiac surgery is considered an option to reduce the need of allogeneic blood products. We analysed a 1-year period of our institutional database according to the safety and efficiency of our autologous blood donation programme. METHODS:All patients who donated autologous blood prior to cardiac surgery were matched to a non-donor according to age, body weight, body mass index, sex, haemoglobin concentration, EuroSCORE, antifibrinolytic therapy and risk for bleeding. We analysed the occurrence of adverse effects during donation in all donors as well as the main perioperative data, haemoglobin levels and the need for allogeneic blood transfusion in all patients. RESULTS:There were no major cardiac events such as myocardial infarction, worsened cardiac insufficiency or death in the donor group during the PABD process. A total of 216 patients could be matched. Exposure to allogeneic blood products was significantly reduced in the donor group (packed red cells 70 patients (pts) vs 118 pts (p<0.001), fresh frozen plasma 26 pts vs 54 pts (p=0.001), platelets 10 pts vs 22 pts (p=ns)). There were no reports of transfusion-related side effects. Further, there was no difference in haemoglobin concentrations at postoperative day 1 and at discharge. CONCLUSIONS:In this large matched-pair analysis without the need for risk stratification, PABD reduces the need for allogeneic blood products in adult cardiac surgery. In a carefully selected cohort, PABD is a safe and efficient alternative to allogeneic transfusion.
Combined preoperative autologous blood donation and intra-operative cell salvage for hip surgery.
Kubota Reiko,Nozawa Masahiko,Matsuda Keiji,Maezawa Katsuhiko,Kim Sung-Gon,Maeda Kouichi,Ikegami Takashi,Hayashi Kentarou,Nagayama Masataka,Kaneko Haruka
Journal of orthopaedic surgery (Hong Kong)
PURPOSE:To review records of 161 consecutive hip surgery patients for whom preoperative autologous blood donation (PABD) was used in combination with intra-operative cell salvage (ICS). METHODS:114 women and 14 men aged 41 to 86 (mean, 64) years underwent 135 primary total hip arthroplasties (THAs), whereas 19 women and 7 men aged 16 to 52 (mean, 35) years underwent 26 rotational acetabular osteotomies (RAOs). Two or 3 weeks before the operation, patients deposited one unit (400 ml) of blood weekly, so long as their haemoglobin levels exceeded 110 g/l (if they had osteoarthritis) or 100 g/l (if they had rheumatoid arthritis). Patients were given oral ferrous sulphate, lactated Ringer's solution, and recombinant human erythropoietin. 800 and 1200 ml of blood were deposited for patients undergoing THA and RAO, respectively. Intra-operatively, ICS was carried out using a continuous autotransfusion system. The blood from ICS was transfused first, and then the blood from PABD was transfused during the latter half of the operation. RESULTS:By combining PABD and ICS, homologous blood transfusion was avoided in all patients, even in those with unexpected massive bleeding during surgery. In 3 patients, one unit of deposited autologous blood was discarded, because they showed no sign of anaemia. The mean total blood loss was almost 1.5 times higher in RAO than in THA patients (1095 vs 1550 ml). In the THA and RAO patients respectively, the mean amount of ICS was 181 and 210 ml, whereas the mean total blood transfusion volume was 975 and 1394 ml. No complications (including infection) related to autologous blood transfusion were observed during PABD, the surgery or the postoperative period. CONCLUSION:Homologous blood transfusion was avoided with the use of PABD and ICS. Preoperative donation of 800 and 1200 ml of blood (combined with ICS) seemed optimal, as only 3 units of blood were discarded.
Nonanemic patients do not benefit from autologous blood donation before total hip replacement.
Boettner Friedrich,Altneu Eric I,Williams Brendan A,Hepinstall Matthew,Sculco Thomas P
HSS journal : the musculoskeletal journal of Hospital for Special Surgery
To avoid the potential risks of allogeneic transfusion during total hip arthroplasty (THA), the use of preoperative autologous blood donation (PABD) has been utilized. We performed a retrospective chart review of 283 patients undergoing THA that either donated 1 U of autologous blood (188 patients) or did not donate autologous blood before surgery (95 patients) in order to investigate the difference in postoperative transfusion rate (autologous and allogeneic), the incidence of allogeneic transfusion, and the difference in cost of each protocol. In addition, the study compared transfusion rates in patients with and without preoperative anemia (hemoglobin (Hb) ≤ 12.5 g/dL). At 0.75 transfusions per patient versus 0.22 transfusions per patient, the PABD patients had a significantly higher overall transfusion rate. PABD significantly reduced the need for allogeneic blood in anemic patients (Hb ≤ 12.5 g/dL) from 52.6% to 11.8%. PABD did not have the same affect in nonanemic patients (allogeneic transfusion rate 5.7% versus 4.0%). The study demonstrated that nonanemic patients undergoing THA do not benefit from PABD, but it is effective for anemic patients.
Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial.
Jakovina Blazekovic Sanja,Bicanic Goran,Hrabac Pero,Tripkovic Branko,Delimar Domagoj
PURPOSE:During total knee arthroplasty (TKA) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions. For blood loss management during TKA, pre-operative autologous blood donation (PABD) is still a standard of care. In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and, if yes, for which group of patients. METHODS:Patients were randomised to three groups. In group 1 patients did not donate autologous blood, in group 2 patients donated 1 dose 72 hours prior to TKA and in group 3 patients donated autologous blood 14 days prior to TKA. In all patients haemoglobin, haematocrit, thrombocyte and reticulocyte values, iron concentrations (Fe, unsaturated iron binding capacity, total iron binding capacity), activated partial thromboplastin time, prothrombin time, and intra-operative and post-operative blood loss were measured and compared. RESULTS:With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded, which significantly increased the cost of treatment for these patients. For patients undergoing TKA, PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion. CONCLUSIONS:Results of our study showed that PABD in non-anaemic patients is not justified and is not economically feasible.
Pre-operative blood donation versus acute normovolemic hemodilution in cardiac surgery.
Nobahar Mohammad Rezvan,Chegini Azita,Behnaz Faranak
Saudi journal of anaesthesia
INTRODUCTION:Acute normovolemic hemodilution (ANH) and preoperative autologous blood donation (PABD) have questionable efficacy, viral and bacterial infection risks, intermittent blood shortages as homeostasis problem, electrolyte and hemodynamic disturbances. MATERIALS AND METHODS:In this cross sectional survey, we studied 70 patients undergoing open heart coronary artery bypass grafts [CABG] and different valvular replacement 1 ml surgery (35 in ANH, 35 in PABD) in Shaheed Modares - Hospital. We measured electrolytes and homeostatic factors to evaluate the influence of two transfusion methods on homeostatic function and hemodynamic balance. RESULTS:We compared 70 patients (38 male [54.3%] and 32 female [45.7%]) with mean age 54.8 years undergoing open heart surgery (CABG and valvular). In ANH group, significant decrease was detected in Na (28.5%) K (2.5%), prothrombin time (PT) (88.57%), partial thromboplastin time (PTT) (94.28%), creatine phosphokinase (CPK) (11.4%), lactic dehydrogenase (LDH) (11.43%), albumin (Alb) (17.14%), globulin (91.43%) and total protein (80%). Mean initial and post-operative hemoglobin was 14.12 ± 1.06 versus 11.97 ± 0.98, hematocrit 42.22 ± 3.45 versus 35.40 ± 2.88, systolic blood pressure 124.1 ± 14.4 versus 110.88 ± 15.6 (reduction 22.86%) diastolic blood pressure 76.02 ± 10 versus 69.26 ± 11 (reduction 3%) and pulse rate was 75.45 ± 10 versus 84.45 ± 12 (12%) in this case difference between two groups was strongly significant (P = 0.001). In PABD group, significant decrease was detected in Na (20%), K (2.5%), PT (91.43%) PTT (80%), CPK (8.57%), LDH (5.72%), Alb (57.15%), globulin (71.43%) and total-protein (62.85%), the value of hemodynamic changes were in normal range. CONCLUSION:Though autologous blood transfusion (ANH and PABD) was preferable to allogeneic transfusion in cardiac surgical patients; but PABD offers more advantages in homeostasis, hemodynamic stability and electrolyte balance.
Effect of preoperative autologous blood donation on patients undergoing bimaxillary orthognathic surgery: a retrospective analysis.
Oh A Y,Seo K S,Lee G E,Kim H J
International journal of oral and maxillofacial surgery
The efficacy of preoperative autologous blood donation (PABD) was evaluated according to preoperative haemoglobin (Hb) values. The records of 295 patients who underwent bimaxillary orthognathic surgery between July 2007 and August 2008 were reviewed. The records for autologous blood donation, intraoperative transfusion, and related laboratory studies were also evaluated. The transfusion trigger used during this period was Hb < 10 g/dl. A total of 189 patients (64.1%) made a PABD and 106 patients (35.9%) did not. The incidence of allogeneic blood transfusion was significantly lower in the PABD group than in the no PABD group (15.9% vs. 29.2%, P = 0.007). This difference was greater in patients with a preoperative Hb < 14 g/dl (20.3% vs. 62.5%, P < 0.0001), and no difference was found in patients with Hb ≥ 14 g/dl (13.3% vs. 14.9%, P = 0.83). PABD reduced the incidence of allogeneic blood transfusion in patients undergoing bimaxillary orthognathic surgery, particularly in patients with a preoperative Hb < 14 g/dl. PABD could be used to reduce the frequency of intraoperative allogeneic blood transfusion in these patients.
Preoperative autologous blood donation versus intraoperative blood salvage: intraindividual analyses and modeling of efficacy in 1103 patients.
Singbartl Guenter,Schreiber Joerg,Singbartl Kai
BACKGROUND:Preoperative autologous blood donation (PABD) and intraoperative blood salvage (IBS) represent established blood conservation measures. However, data comparing PABD to IBS are very sparse. STUDY DESIGN AND METHODS:We analyzed data from 1103 patients undergoing PABD and subsequent major orthopedic surgery in one center. We then used a validated model to compare PABD to IBS. We calculated maximal allowable blood losses (MABLs) for both IBS and PABD. We also identified criteria for efficacious use of either PABD or IBS. Our calculations were based on exclusive application of either technique, complete exhaustion of predeposited or salvaged blood, and one round of IBS. RESULTS:The vast majority of patients would have tolerated greater MABLs if subjected to IBS rather than PABD (425 of 432 with 1 PABD unit, 580 of 664 patients with 2 PABD units, 3 of 7 patients with 3 PABD units). For a few patients, however, our model demonstrated greater MABL with PABD than with IBS. These patients were characterized by 1) lower initial hematocrit (Hct), 2) recovery from PABD with return to baseline Hct or above by the time of surgery, and 3) longer time between first PABD and surgery. CONCLUSION:IBS appears to be the superior blood conservation technique if PABD cannot be performed under optimal conditions. Tolerable predonation anemia and sufficient time for regeneration appear to be crucial for post-PABD erythropoiesis. If these goals cannot be accomplished, PABD should be abandoned and be replaced by IBS.
Decreasing preoperative autologous blood donation: collaboration between a hospital and a blood center to prompt change in physician ordering behavior.
Su Leon L,Adamski Jill,Gilman Elizabeth A,Cusick Robin,Hernandez James S
OBJECTIVE:To describe the collaborative efforts of a large healthcare institution and its local blood center in reducing preoperative autologous blood donation (PABD). METHODS:Through an educational letter-based campaign, we contacted physicians who historically had ordered PABD units. Follow-up educational efforts occurred at departmental and individual meetings. RESULTS:Our educational campaign to reduce PABD achieved complete elimination of PABD orders and the resultant waste of PABD units within 3 years of the start of the program. These changes were sustained for at least 2 subsequent years without the need for additional educational efforts. CONCLUSION:Targeted educational efforts directed at practitioners of PABD were successful in significantly decreasing the use and waste of PABD at the health care institution we studied and may yield the same results in comparable institutions.
[Usefulness of reticulocyte hemoglobin equivalent for the safety of pre-operative autologous blood donation].
Shibayama Masami,Takami Akiyoshi,Kimura Mika,Takamichi Sayuri,Sakai Yoshio,Wada Takashi
Rinsho byori. The Japanese journal of clinical pathology
Pre-operative autologous blood donation (PABD) provides safe blood for patients at the expense of the risk of iron deficiency anemia that may compromise the patients. The reticulocyte hemoglobin equivalent (RET-He) is an indirect measure of the functional iron available for the erythropoiesis over the previous 2-3 days. The aim of this study was to evaluate the clinical usefulness of RET-He quickly measured by the automated hematology analyzer Sysmex XE-2100 in patients undergoing PABD at our hospital. Receiver-operating characteristic curve analysis revealed that RET-He was reliable in the diagnosis of iron deficiency anemia. Two of 14 patients in the absence of post-PABD iron replacement developed marked anemia with low RET-He levels after PABD, suggesting that this anemia was due to iron deficiency. Of 26 patients receiving post-PABD iron replacement, 8 who had already showed low RET-He levels at PABD developed statistically significant reduction in hemoglobin levels after PABD despite adequate iron replacement, indicating that the 8 patients had iron deficiency prior to PABD. These findings suggest that automated measurement of RET-He may contribute to improve the safety of PABD.
Efficacy of preoperative autologous blood donation for elective posterior lumbar spinal surgery.
Kennedy Cian,Leonard Micheal,Devitt Aiden,Girardi Federico P,Cammisa Frank P
STUDY DESIGN:Retrospective review. OBJECTIVE:Evaluate the transfusion patterns associated with preoperative autologous blood donation (PABD) during posterior lumbar spinal surgery. SUMMARY OF BACKGROUND DATA:There is a paucity of evidence in the literature examining the utility of PABD in elective adult lumbar spinal surgery. METHODS:Medical records of 541 patients treated for spinal stenosis between January 1997 and February 2000 were reviewed. Patients were divided into donors (PABD; n = 413) and nondonors (non PABD [NPABD]; n = 128). RESULTS:Average preoperative hemoglobin (Hb) in the NPABD group was 0.62 units more than in the PABD group (95% confidence interval [CI] = 0.30-0.94). For PABD patients, there was a negative correlation (-0.3) between preoperative Hb and number of units donated. PABD patients who donated 1 and 2 units of blood were, respectively, 7.5 and 9 times more likely to be transfused within the first 24 hours than NPABD patients. NPABD patients were 25 times more likely to need a transfusion of allogeneic blood than PABD patients who donated at least 2 units of blood. Autologous donation was an independent predictor of perioperative blood loss (P < 0.05). Patients who donated at least 2 units of blood lost approximately 1.3 units of Hb more than NPABD patients. The odds of wastage for a PABD patient who had a decompression with noninstrumented fusion were 8.64 times that of a PABD patient who had a decompression with instrumented fusion. CONCLUSION:Autologous blood donation induced preoperative anemia and resulted in a lower transfusion threshold than allogeneic blood usage. In addition, we found that autologous donation significantly increased blood loss in the preoperative period as measured by Hb lost. Usage of autologous blood was significantly more efficient in patients who underwent instrumented fusion than in patients with less complex surgery.
Comparison of whole blood collection and double-unit erythrocytapheresis in preoperative autologous blood donation.
Kim Miyoung,Kim Hyung Suk,Kim Yang Hyun,Choi Ji Seon,Yang Hoon Joo,Hwang Soon Jung,Kim Myung Jin,Lee Jong Ho,Choi Jin Young,Han Kyou-Sup
Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis
INTRODUCTION:We compared preoperative autologous blood donation (PABD) using serial manual whole blood (WB) and PABD using a single session, double-unit erythrocytapheresis in terms of the hemodynamic recovery and clinical outcomes. MATERIALS AND METHODS:This study included 56 donors in the WB PABD group and 117 donors in the double-unit erythrocytapheresis PABD group. All subjects were men with body weight >70 kg, Hb level >13.3g/dL, Hct >40%, and who were scheduled for oral and maxillofacial surgery. Three cycles of manual WB collection for PABD or a single session, double-unit erythrocytapheresis using the Alyx was performed. RESULTS:There were no significant differences in donor demographic variables including age, height, weight, Hb, Hct, or red cell mass between the 2 groups. The double-unit erythrocytapheresis was completed earlier than the last manual WB PABD (at 15.3 ± 4.7 days and 6.5 ± 3.2 days before surgery, p<0.001). Hct values before surgery were higher in the double-unit erythrocytapheresis PABD group than in the manual WB PABD group (39.7 ± 3.2 vs. 38.6 ± 2.7, p=0.024). ΔHct and %ΔHct before the first PABD and before surgery were lower in the double-unit erythrocytapheresis PABD group than in the manual WB PABD group (-5.6 ± 2.8 vs. -6.8 ± 2.7, p=0.010 and -12.3 ± 5.9 vs. -14.8 ± 5.6, p=0.008, respectively). The incidence of additional allogeneic blood transfusions during or after surgery and the post-operative Hb and Hct values were similar in the 2 groups. The length of hospital stay after surgery was significantly longer in the manual WB PABD group than in the double-unit erythrocytapheresis group (6.1 ± 2.5 vs. 5.4 ± 1.9, p=0.043). Of the 33 donors in the double-unit erythrocytapheresis PABD group, 7 (21.2%) reported discomforts related to the procedure, and 6 graded the discomforts (hypocalcemia, perioral tingling sense, paresthesia, dizziness, stuffiness, pain on the intravenous site, and muscle tension) as mild. CONCLUSION:The single session, double-unit erythrocytapheresis prolonged the time interval between PABD and surgery and led to better hemodynamic recovery than the serial manual WB PABD, and hypocalcemic symptoms were mild.
Optimal preoperative autologous blood storage volume required in surgeries for placenta previas and low-lying placentas.
Sakai Ayumi,Matsunaga Shigetaka,Nakamura Eishin,Samejima Kouki,Ono Yoshihisa,Yamamoto Koji,Takai Yasushi,Maeda Hiroo,Seki Hiroyuki
The journal of obstetrics and gynaecology research
AIM:The high rate of stored preoperative autologous blood wastage is concerning. This study analyzed patients who provided preoperative autologous blood donations (PABDs) for massive bleeding during surgery for placenta previas and low-lying placentas, and investigated the optimal PABD storage volume required to avoid allogeneic transfusion. METHODS:Of 386 patients who provided PABDs at our hospital from 2008 to 2013, 269 patients with placenta previas or low-lying placentas were retrospectively analyzed. The PABD storage volumes were stratified into four groups based on the amounts stored, and the allogeneic transfusion usage frequencies were compared. RESULTS:A total of 124 patients (46.1%) received PABDs and 12 patients (4.5%) received allogeneic transfusions. The average PABD volume wasted was 23 940 mL/year. The allogeneic transfusion utilization rate was significantly higher in the 1- to 300-mL group (17.2%) than in the 301- to 600-mL (1.69%), 601- to 900-mL (3.82%), and 901- to 1200-mL (0%) groups (P < 0.05). The PABD cut-off volume for avoiding allogeneic blood transfusion was 300 mL, and the odds ratio for ≤300-mL PABD in a multivariate analysis was 14.3 (95% confidence interval 1.3-149.3; P = 0.03). The maximum surgical blood order schedule was 2.16 units (432 mL), and the surgical blood order equation was 2.15 units (430 mL). CONCLUSION:The allogeneic transfusion utilization rate did not differ between the 600-mL group and the groups with higher PABD storage volumes; hence, storing 600 mL of PABD was appropriate for surgery for placenta previas and low-lying placentas.
The effect of pre-operative autologous blood donation self-transfusion on hormone and postpartum convalescence in Lying-in women.
Ding Jiefeng,Hua Kai,Chen Haijiang,Yang Diqiong,Wang Lie
International journal of clinical and experimental medicine
The aim of the study is to investigate the feasibility of pre-operative autologous blood donation (PABD) self-transfusion on the postpartum recovery and the endocrine in lying-in women. The PABD is carried out on 70 pregnant women who have high risk of postpartum hemorrhage. Those 70 subjects were divided into three groups: 33 cases of PABD self-transfusion during the Cesarean section; 16 cases of PABD self-transfusion as a physiological means and 21 cases without transfusion. Serum levels of Estradiol (E2), Progesterone (P), Prolactin (PRL) hormone are evaluated 48 hours before and after labor; Postpartum colostrum timing, milk yield, short term and long term uterine contraction are observed among the cases. No significance were observed among the three groups on E2, P, PRL hormone 48 hours before and after labor. The PRL concentration in PABD self-transfusion group is higher than that in the group without self-transfusion 48 hours after labor. Using different PABD self-transfusion strategies, significant difference of the initial milk yield time were observed in the three groups (F=6.035 P=0.004), but the milk yield is no significant different on second day and third day. The self-transfusion of PABD has little influence on uterine contraction. For the women who underwent Cesarean Section, the PABD self-transfusion is conducive to the increase of PRL level. The PABD self-transfusion advances the commencement time of milk yield, while with little effect on neither milk yield volume nor uterine contraction.
Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries: a propensity-matched cohort analysis.
Kelly Michael P,Zebala Lukas P,Kim Han Jo,Sciubba Daniel M,Smith Justin S,Shaffrey Christopher I,Bess Shay,Klineberg Eric,Mundis Gregory,Burton Douglas,Hart Robert,Soroceanu Alex,Schwab Frank,Lafage Virginie,
Journal of neurosurgery. Spine
OBJECTIVE:The goal of this study was to examine the effectiveness of preoperative autologous blood donation (PABD) in adult spinal deformity (ASD) surgery. METHODS:Patients undergoing single-stay ASD reconstructions were identified in a multicenter database. Patients were divided into groups according to PABD (either PABD or NoPABD). Propensity weighting was used to create matched cohorts of PABD and NoPABD patients. Allogeneic (ALLO) exposure, autologous (AUTO) wastage (unused AUTO), and complication rates were compared between groups. RESULTS:Four hundred twenty-eight patients were identified as meeting eligibility criteria. Sixty patients were treated with PABD, of whom 50 were matched to 50 patients who were not treated with PABD (NoPABD). Nearly one-third of patients in the PABD group (18/60, 30%) did not receive any autologous transfusion and donated blood was wasted. In 6 of these cases (6/60, 10%), patients received ALLO blood transfusions without AUTO. In 9 cases (9/60, 15%), patients received ALLO and AUTO blood transfusions. Overall rates of transfusion of any type were similar between groups (PABD 70% [42/60], NoPABD 75% [275/368], p = 0.438). Major and minor in-hospital complications were similar between groups (Major PABD 10% [6/60], NoPABD 12% [43/368], p = 0.537; Minor PABD 30% [18/60], NoPABD 24% [87/368], p = 0.499). When controlling for potential confounders, PABD patients were more likely to receive some transfusion (OR 15.1, 95% CI 2.1-106.7). No relationship between PABD and ALLO blood exposure was observed, however, refuting the concept that PABD is protective against ALLO blood exposure. In the matched cohorts, PABD patients were more likely to sustain a major perioperative cardiac complication (PABD 8/50 [16%], NoPABD 1/50 [2%], p = 0.046). No differences in rates of infection or wound-healing complications were observed between cohorts. CONCLUSIONS:Preoperative autologous blood donation was associated with a higher probability of perioperative transfusions of any type in patients with ASD. No protective effect of PABD against ALLO blood exposure was observed, and no risk of perioperative infectious complications was observed in patients exposed to ALLO blood only. The benefit of PABD in patients with ASD remains undefined.
Effects of Preoperative Autologous Blood Donation in Patients Undergoing Minimally Invasive Cardiac Surgery.
Lim Mi Hee,Je Hyung Gon,Ju Min Ho,Lee Ji Hye,Oh Hye Rim,Kim Ye Ri
The Korean journal of thoracic and cardiovascular surgery
Background:Preoperative autologous blood donation (PABD) is a conservation strategy for reducing allogenic blood transfusion (ABT) during minimally invasive cardiac surgery (MICS). We aimed to evaluate the effects of PABD on the frequency of ABT and clinical outcomes in patients undergoing MICS. Methods:We enrolled 113 patients (47.8±13.1 years, 50 men) undergoing MICS without preoperative anemia (hemoglobin >11 g/dL) between 2014 and 2017. Of these patients, 69 (the PABD group) donated autologous blood preoperatively and were compared to the non-PABD group (n=44). We analyzed the frequency of perioperative ABT and clinical outcomes. Results:Baseline characteristics did not significantly differ between groups, although preoperative hemoglobin levels were lower in the PABD group. All operations were performed using a minimally invasive approach. Patients' surgical profiles were similar. There were no cases of mortality or significant differences in early postoperative outcomes. During the early postoperative period, hemoglobin levels were higher in the PABD group. No significant difference was found in the frequency of ABT. Conclusion:Although the PABD group had higher postoperative hemoglobin levels, there was no clear clinical benefit in the early postoperative period, despite a great deal of effort and additional cost. Additional PABD in the setting of strict policies for blood conservation was ineffective in reducing ABT for young and relatively healthy patients who underwent MICS.
[Clinical Application of Preoperative Autologous Blood Donation in Selective General Surgery].
Huang Hui-Ying,Hunag Jian-Yun,Wei Ya-Ming,Zhong Ming-Lu,Wang Chuan-Xi
Zhongguo shi yan xue ye xue za zhi
OBJECTIVE:To study the clinical effects of preoperative autologous blood donation (PABD) in selective general surgery. METHODS:Paired study was performed in PABD group with 70 PABD cases screened from selective general surgery during the period from November 2017 to August 2018 in our hospital, and the control group included 70 cases without preoperative autologous blood donation, the baseline data before surgery were not significantly different. The transfusion quantities of allogeneic RBC and plasma, the levels of perioperative hemoglobin and platelets, the time and expense of hospitalization were compared between two groups. RESULTS:The levels of Hb and Plt in PABD group before and after blood collection were determined as follows: 138.26±14.73 g/L vs 127.52±13.36 g/L (P＜0.05) and (221.67±52.86)×10/L vs (198.35±52.65)×10/L (P＞0.05) respectively. The analysis of allo-RBC and allo-plasma transfusion in PABD group and control group showed that: the quantity of allogeneic RBC transfusion was 0.20±0.71 U and 0.89±0.97 U, and the quantity of allogeneic plasma transfusion was 30.43±100.81 ml and 106.52±152.61 ml (P＜0.05) respectirdy during perioperation. The comparison results of preoperative Hb and plt in PABD group and control group were 135.65±14.16 g/L vs 134.15±11.98 g/L and (270.36±58.28)×10/L vs (271.67±65.02) ×10/L respectively. The levels of postoperative Hb and plt in PABD group and control group were 120.24±14.40 g/L vs 121.20±14.30 g/L at 1 d after operation, and (241.80±63.58)×10/L vs (241.30±69.11)×10/L at 1 d after operation respectively; 123.15±13.80 g/L vs 121.65±14.33 g/L at 3 d after operation and (251.26±72.94)×10/L vs (255.54±73.85)×10/L at 3 d after operation; 122.78±13.92 g/L and 122.00±13.82 g/L (before discharge) and (262.50±80.96)×10/L and (264.56±71.08)×10/L (before discharge, platelet). These data were not statistically different (P＞0.05). The hospitalization time was 14.84±3.37 days and 14.84±2.24 days, respectively, without statistical difference (P＞0.05) in two groups. The expenses of hospitalization and the blood transfusion in two groups were 50627.27±9889.45 RMB and 50979.43±8195.00 RMB; 354.39±362.57 RMB and 684.02±425.53 RMB (P＜0.05). CONCLUSION:The application of PABD reduces the use of allogeneic blood and costs for patients undergoing selective surgery with blood losts of 1000 ml.
Overtransfusion of Autologous Blood Identifies Opportunities for Improving Patient Blood Management.
Perez Alejandro,Bakhtary Sara,Nedelcu Elena,Manuel Solmaz
Background Preoperative autologous blood donation (PABD) has been declining in use nationally. A subset of patients scheduled for elective surgery, however, continue to be offered and choose this option. Our study aimed to understand the current impact of PABD before scheduled surgical procedures. Study design and methods A retrospective review was conducted in a single large academic center. Medical records associated with autologous units received in the transfusion service over a two-year period (1/1/2016-12/31/2017) were reviewed. Demographics, units donated, units transfused, wastage, pre-donation hemoglobin (Hb), pre-operative Hb, estimated blood loss (EBL), and clinical specialty were collected. Results During the study period, 118 patients underwent PABD, donating a total of 141 autologous red blood cell units. Patients who donated autologous units and were subsequently transfused had lower pre-donation Hb compared to patients who were not transfused (13.3 ± 1.4 g/dL vs. 14.3 ± 1.5 g/dL, p=0.004). Pre-operative Hb was lower than pre-donation Hb among both groups (12.1 ± 1.2 g/dL for patients receiving transfusion; 12.9 ± 1.5 g/dL, p=0.011 for patients who were not transfused). The majority of PABD patients (71%) had an estimated blood loss of less than 500 mL. Wastage rate of autologous units was 67%. PABD was disproportionately associated with a minority of surgeons and clinical services. Conclusion Within our institution, PABD is heavily used amongst a small subset of physicians across multiple surgical specialties and is associated with lower pre-operative Hb, tendency towards overtransfusion, and high rates of wastage of donated units. Our findings reinforce reports of inefficiencies in patient blood management and increased risks to patient health associated with PABD.