Short donation intervals in preoperative autologous blood donation in the concept of autologous transfusion . German
Wittig M, Osswald PM, Lorentz A, Jani L
Homologous transfusion is associated with infectious and immunological risks. Preoperative autologous deposit reduces homologous transfusion requirements considerably. Usually donations are carried out at weekly intervals. In this study we investigated the effect of shorter donation intervals on erythropoiesis and perioperative transfusion requirements. METHODS. A total of 40 consecutive patients scheduled for hip arthroplasty and taking part in an autologous donation programme were randomly assigned to two groups: group I gave blood on days 0, 3, 7 (and 14), group II at weekly intervals. The aim was deposit of three blood units of 450 ml. A patient was deferred if hemoglobin concentration prior to donation fell below 11 g/dl, and in this case 100 mg Fe 2+ three times daily was prescribed. Blood was stored with CP-DA-1 anticoagulant. Surgery was performed between day 28 and 35. A perioperative hemoglobin concentration lower than 9 g/dl was considered a transfusion trigger. RESULTS. Group I was made up of 21 patients (10 women, 11 men, aged 39-69 years) who gave blood at short intervals, and group II of 19 patients (10 women, 9 men, aged 37-77 years) who gave blood at weekly intervals. General data, calculated blood volume and erythrocyte mass prior to donation were comparable. Each patient donated three units. Four patients had to be deferred once, one in group I, three in group II. The hemoglobin concentration in group I decreased from 13.9 +/- 1.2 g/dl (mean +/- SD) to 13.3 +/- 1.0 g/dl prior the operation, in group II from 13.5 +/- 1.3 g/dl to 12.5 +/- 1.1 g/dl. Preoperatively the hemoglobin concentrations differed significantly (P < 0.05), as did calculated erythrocyte mass (1633 versus 1474 ml, P < 0.05). Reticulocytes increased from 46 x 10(3)/microliters (median) to a maximum of 94 x 10(3)/microliters on day 7 in group I, and from 44 x 10(3)/microliters to 108 x 10(3)/microliters in group II on day 14. Serum ferritin decreased from 122 micrograms/l (median) to 82 micrograms/l in group I, and from 140 micrograms/l to 77 micrograms/l in group II. These parameters did not differ statistically between the two groups. Intra- and postoperative blood loss amounted to 2175 ml (median) in group I versus 1430 ml in group II (P < 0.05). The perioperative hemoglobin concentration was similar in the two groups. Homologous transfusion requirements were similar in the two groups (1 unit in group I, vs 3 units in one patient and 1 unit in two patients in group II). CONCLUSIONS. Short donation intervals resulted in a higher preoperative erythrocyte mass after similar preoperative deposit, and significantly higher blood loss was tolerated with similar homologous transfusion volume.
A comparison of autologous transfusion procedures in hip surgery German
Lorentz A, Osswald PM, Schilling M, Jani L
The risks associated with transfusion can be minimized with autologous blood. The efficiency of preoperative deposit, preoperative hemodilution and intra- and postoperative autotransfusion in reducing homologous transfusions has been demonstrated. There seem to be few studies, however, that compared the different methods of autologous transfusion. This study was designed to evaluate the comparative efficiency of these methods. PATIENTS AND METHODS. Sixty-four patients scheduled for total hip arthroplasty were randomly divided into four groups: group I--preoperative autologous deposit: group II--preoperative hemodilution; group III--intra- and postoperative autotransfusion; group IV--control. Preoperative autologous donations were stored in CPDA-1 buffer. Three units of 450 ml were requested. A predonation hemoglobin (Hb) concentration of 11 g dl was required. Surgery was carried out in the 5th week after the first donation. Preoperative hemodilution to Hb 9 g/dl was carried out after induction of anesthesia and initial circulatory stabilization. A cell separator was used for intra- and postoperative autotransfusion. Postoperative autotransfusion of drainage blood was continued until 6 h after the beginning of the operation. Polygeline was used for volume resuscitation. If the Hb concentration fell below 9 g/dl in the operating room and intensive care unit or below 10 g/dl in the general ward, autologous blood or homologous packed red cells were transfused. Autologous blood collected with the cell separator was retransfused at the end of the operation and after the autotransfusion period irrespective of the actual Hb concentration. RESULTS. The general data of the patients, blood loss, and Hb concentration at the beginning of the study and postoperatively were comparable in the four groups. Homologous transfusion requirements amounted to 0 (0-1250) ml (median, range) packed red cells in group I (preoperative deposit). 500 (0-2000) ml in group II (hemodilution), 125 (0-1000) ml in group III (autotransfusion) and to 500 (0-1500) ml in group IV (control). In group I 14 of 16 patients, in group II 1 of 16, in group III 8 of 16 patients, in group IV 5 of 15 patients did not require homologous transfusion. The difference between group I and IV was significant (p = 0.004 and p = 0.003). Global coagulation tests, antithrombin III, and total serum protein were comparable in the four groups. DISCUSSION. The efficiency of preoperative hemodilution to reduce homologous transfusion requirements is limited]. In the present study, as in two other recent studies, hemodilution did not reduce homologous transfusion requirements. Autotransfusion with a cell separator can save approximately 50% of the erythrocytes lost during hip arthroplasty and 70% of the drainage loss. The homologous transfusion requirements for the autotransfused group reported here were less than in the control group; the difference, however, was not statistically significant. Patients participating in preoperative autologous deposit did not require homologous blood for hip arthroplasty in 62%-70% of cases in other investigations; in the present study 88% of the patients did not require homologous blood. CONCLUSION. Under the conditions studied, preoperative autologous deposit was the most efficient method of autologous transfusion for hip arthroplasty. It should be employed primarily.
Calculation of the allowable blood loss before transfusion with a programmable pocket calculator . German
Lorentz A, Gasteiger P, Osswald PM
Der Anaesthesist. 1987;36((6):):306-12.
Introduction. The amount of blood loss during surgery that requires transfusion is frequently estimated with a linear formula (1) using blood volume--calculated on a volume per weight basis--, preoperative hemoglobin concentration, and an established minimum hemoglobin concentration. This formula, however, underestimates allowable pretransfusion blood loss, because it implies that all blood lost contains the initial hemoglobin concentration. In addition, hemodilution by infusion therapy prior to surgery is usually not taken into consideration. Methods. In order to estimate allowable pretransfusion blood loss more accurately and conveniently, a program was developed for a programmable pocket computer. This program calculates (number of equation in parenthesis): blood volume (2a, 2b) expansion of blood volume prior to surgery (3) hemodilution prior to surgery (4) allowable blood loss during isovolemic hemodilution (5). The applicability of the program to the situation during orthopedic operations was tested in a study in which allowable pretransfusion blood loss was estimated for one group of patients and was calculated with the computer program for another group of patients. Eighty patients undergoing major orthopedic surgery were studied. After preoperative evaluation the attending anesthetist established a minimum hemoglobin concentration and the type of cardiocirculatory monitoring to be used. Patients were divided at random into two groups: for one group blood volume was estimated on a volume per weight basis and allowable blood loss was calculated using equation (1); for the second group allowable blood loss was calculated with the computer program. During the evaluation of the data the computer calculations were also carrier out for group 1.(ABSTRACT TRUNCATED AT 250 WORDS)