Volume replacement during aortic surgery: Homologous vs. autologous blood? (original) (raw)
Related papers
Considerations on Autologous Blood Transfusion
Journal of Anesthesia & Critical Care: Open Access, 2016
a week, but the last should occur no less than 72 hours before surgery to allow time for restoration of intravascular volume. Candidates for preoperative collection should be stable patients scheduled for surgical procedures in which blood transfusion is likely. The most common surgical procedures that probably required transfusion are major orthopedic procedures, vascular surgery, cardiac or thoracic surgery, and radical prostatectomy [2]. When the transfusion is not likely (less than 10 %) the use of preoperative blood collection is not recommended. Those cases include cholecystectomy, herniorrhaphy, vaginal hysterectomy, and uncomplicated obstetric delivery [3]. Contraindications of autologous blood donation: The contraindications of autologous blood transfusion are summarized in Table 1. In the patients with cardiac current diseases, the risks that are associated with autologous blood donation [4] in these patients are greater than estimated current risks of allogeneic transfusion [5,6]. The autologous blood donation from pregnant women is not recommended [7], because blood is so seldom needed. AD can be considered for women with alloantibodies to multiple or high-incidence antigens or with placenta previa or other conditions placing them at high risk for antepartum or intrapartum hemorrhage [8]. AABB Standards no longer permit allogeneic transfusion of unused autologous units ("crossover") because autologous donors are not, in the strictest sense, volunteer donors. That experience concorde with our experience. Aggressive phlebotomy vs. Standard phlebotomy: If the erythropoietic process does not respond to blood phlebotomy in order to maintain the patient's hematocrit level during the donation interval, the donation may be harmful [9] causing preoperative anemia and an increased possibility of allogeneic blood transfusion. "Aggressive" autologous blood phlebotomy means donation twice weekly for 3 weeks, beginning 25 to 35 days before surgery. The endogenous erythropoietin levels will increase, along with enhanced erythropoiesis representing RBC volume expansion of 19% to 26% (Table 2). Exogenous erythropoietin (Eprex) therapy can further stimulate erythropoiesis (up to 50% RBC volume expansion [10-17]. Preoperative use of erythropoietin is approved for anemic (Hct < 39%) patients scheduled for no cardiac, nonvascular surgeries. Table 1: Contraindications of Autologous Blood Donation. Evidence of infection and risk of bacteremia Scheduled surgery to correct aortic stenosis Unstable angina Active seizure disorder Myocardial infarction or cerebrovascular accident within 6 months of donation Patients with significant cardiac or pulmonary disease who have not yet been cleared High-grade left main coronary artery disease Cyanotic heart disease Uncontrolled hypertension
Hypothesis: Intraoperative cell salvage (CS) of shed blood during emergency surgical procedures provides an effective and cost-efficient resuscitation alternative to allogeneic blood transfusion, which is associated with increased morbidity and mortality in trauma patients.
Clinical Orthopaedics & Related Research, 2012
Background Mechanical autotransfusion systems for washed shed blood (WSB) were introduced to reduce the need for postoperative allogenic blood transfusions (ABTs). Although some authors have postulated decreased requirements for ABT by using autologous retransfusion devices, other trials, mostly evaluating retransfusion devices for unwashed shed blood (USB), verified a small or no benefit in reducing the need for postoperative ABT. Because of these contradictory findings it is still unclear whether autologous retransfusion systems for WSB can reduce transfusion requirements. Questions/purposes We therefore asked whether one such autologous transfusion system for WSB can reduce the requirements for postoperative ABT. Methods In a prospective, randomized, controlled study, we enrolled 151 patients undergoing TKA. In Group A (n = 76 patients), the autotransfusion system was used for a total of 6 hours (intraoperatively and postoperatively) and the WSB was retransfused after processing. In Control Group B (n = 75 patients), a regular drain without suction was used. We used signs of anemia and/or a hemoglobin value less than 8 g/dL as indications for transfusion. If necessary, we administered one or two units of allogenic blood. Results Twenty-three patients (33%) in Group A, who received an average of 283 mL (range, 160-406 mL) of salvaged blood, needed a mean of 2.1 units of allogenic blood, compared with 23 patients (33%) in Control Group B who needed a mean of 2.1 units of allogenic blood. Conclusions We found the use of an autotransfusion system did not reduce the rate of postoperative ABTs. Level of Evidence Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
A review of nearly two decades in an autologous blood programme: the rise and fall of activity
Transfusion Medicine, 2006
Autologous blood donation (ABD) has been widely recommended. Data from one of the oldest hospital-based programmes in Canada describe both activities and drawbacks. Data were compared over the nearly two decades of activity that peaked in 1996. A 5-year review of recent activity showed that of the 2410 patients referred for consideration, 1823 (75Á64%) were accepted into the programme. Surgical services requested 5825 units of autologous blood. Of these, 3147 units were donated by 1536 patients, 803 units were transfused in the operating room and 558 units were given postoperatively. In total, only 1361 units (43Á25%) were transfused. The mean age of the patients was 58 years (median 61 years and mode 69 years). The haemoglobin concentrations before donation were significantly higher, averaging 145Á2 g L 21 before donation and 114Á9 g L 21 immediately before surgery, whereas at the time of discharge, the haemoglobin concentration averaged 126Á2 g L 21 (P ¼ 0Á0001) in transfused patients. Data from this well-established ABD programme indicate less than 50% overall utilization. The activity in the programme increased until 1996 following which it dropped progressively. The low haemoglobin concentration after surgery is of concern and should foster a transfusion algorithm for these patients.
Benefits and Risks of Blood Transfusion in Surgical Patients
World J Surgery, 1996
This article attempts to put into a risk-related perspective modern red blood cell (RBC) transfusion therapy. When making the decision to transfuse, RBCs or blood products, it is important to weigh the risks and benefits of the proposed therapy. It is equally important to evaluate the risk of not transfusing and the morbidity and mortality associated with that decision. After nearly a century of use, RBC transfusions continue to be associated with a variety of risks. Although the initial risks of mismatch and infectious disease transmission are ever decreasing, new risk considerations, particularly immunosuppression, are being uncovered. Because of the nearly universal worldwide fear of transfusion-related transmission of infectious disease a more conservative transfusion policy has generally taken hold. Transfusion avoidance philosophies and then increased use of autologous RBCs have become commonplace. This article puts a decision-oriented slant on the risk and benefit of transfusion therapy. The issues behind the inability to discern a defined benefit as well as a commentary on the newly perceived risks is provided. Overall, when increased oxygen delivery is required, the addition of RBCs has an apparent survival benefit in some specific patients. In these patients the risk of transfusion-related complication is minimized compared to the mortality outcome. For cancer and trauma patients, if transfusion is immunosuppressive and therefore detrimental, alternatives must be considered. The newest question is whether the act of transfusion, independent of the form, allogeneic or autologous, is of itself immunosuppressive.
Journal of Clinical Anesthesia, 2000
Study Objective: To compare, by model simulation, acute normovolemic hemodilution (ANH) and preoperative autologous blood donation (PABD) to predict their efficacy in current clinical practice. To discuss their similarities and offer guidelines based on expected operative blood loss. Design: Model simulation using data obtained from total hip arthroplasty procedures. Setting: University medical center. Patients: 91 patients who participated in PABD undergoing single, primary, total hip replacement surgeries from January to December 1997. Interventions: A nonanemic (Hb baseline 14 g/dL), average-sized patient (estimated blood volume 5,000 mL) who donated two units by either PABD or ANH was assumed for model simulation. The Hb-final, as a function of 250-mL blood loss increments after retransfusion of two autologous units, was calculated for each technique and compared to a control (nondonor) to predict the effectiveness of PABD and ANH in conserving red cell mass. Data from hip arthroplasties over a 12-month period were used to determine the parameters for the model. Results were subjected to regression analysis and tested for parallelism of slopes, with p Ͻ 0.05 accepted to indicate a statistical difference. Main Results: The difference in Hb-final between PABD and ANH was not statistically different over a wide range of blood loss. When compared to control, there was no difference in Hb-final measurements in the estimated blood loss (EBL) range of less than 1,000 mL. ANH and PABD provide some benefit when EBL is greater than 1,500 mL in nonanemic, average-sized patients. As blood loss increases, the benefit of autologous collection becomes more clinically evident. Conclusion: PABD exemplifies a "chronic" form of ANH in current clinical practice and offers little advantage over ANH as a blood conservation technique for high-blood-loss operations. When surgical blood loss is predictably mild to moderate (range 250 to 1,000 mL), neither blood conservation technique is necessary.
Cardiovascular Journal Of Africa, 2013
Background: The aim of this study was to determine a method to decrease the use of homologous blood during openheart surgery using a simple blood-conservation protocol. We removed autologous blood from the patient before bypass and used isovolumetric substitution. We present the results of this protocol on morbidity and mortality of surgery patients from two distinct time periods. Methods: Patients from the two surgical phases were enrolled in this retrospective study in order to compare the outcomes using autologous or homologous blood in open-heart surgery. A total of 323 patients were included in the study. The autologous transfusion group (group 1) comprised 163 patients and the homologous transfusion group (group 2) 160 patients. In group 1, autologous bloods were prepared via a central venous catheter that was inserted into the right internal jugular vein in all patients, using the isovolumetric replacement technique. The primary outcome was postoperative in-hospital mortality and mortality at 30 days. Secondary outcomes included the length of stay in hospital and in intensive care unit (ICU), time for extubation, re-intubations, pulmonary infections, pneumothorax, pleural effusions, atrial fibrillation, other arrhythmias, renal disease, allergic reactions, mediastinitis and sternal dehiscence, need for inotropic support, and low cardiac-output syndrome (LCOS). Results: The mean ages of patients in groups 1 and 2 were 64.2 ± 10.3 and 61.5 ± 11.6 years, respectively. Thirty-eight of the patients in group 1 and 30 in group 2 were female. There was no in-hospital or 30-day mortality in either group. The mean extubation time, and ICU and hospital stays were significantly shorter in group 1. Furthermore, postoperative drainage amounts were less in group 1. There were significantly fewer patients with postoperative pulmonary complications, pneumonia, atrial fibrillation and renal disease. The number of patients who needed postoperative inotropic support and those with low cardiac output was also significantly less in group 1. Conclusion: Autologous blood transfusion is a safe and effective method in carefully selected patients undergoing cardiac surgery. It not only prevents transfusion-related co-morbidities and complications but also enables early extubation time and shorter ICU and hospital stay. Furthermore, it reduces the cost of surgery.