Autologous blood donations prior to elective cardiac surgery; safety and effect on subsequent blood use

Article Abstract:

Autologous blood donation refers to the practice of donating blood for one's own use at a later date. Blood supplies are drawn and kept in reserve prior to elective surgery. A substantial proportion of blood transfusion recipients are individuals undergoing cardiac (open heart) surgery. The majority of people having this operation require one or more blood transfusions. Advantages of receiving autologous blood over homologous blood, compatible blood donated by other individuals, are the avoidance of transfusion-transmitted disease and possible hemolytic (rejection) reactions. Patients who undergo open heart surgery typically have good long-term survival rates, making the risk of contracting diseases such as hepatitis and acquired immunodeficiency syndrome (AIDS) a particular concern for cardiac patients. The effectiveness and safety of autologous blood transfusion was examined in a study of 291 patients who underwent elective open heart surgery. Of this group, 107 (37 percent) donated blood for their own use prior to the surgery. An infusion of a saline solution was done concurrently with the blood drawing to maintain blood volume. Complications arising from the blood donation by the autologous group were minimal. The group actually experienced fewer problems than what is normally anticipated for other donor populations. In the group that did not provide autologous blood, 82 percent required homologous transfusions, while only 27 percent of the autologous blood donors needed homologous blood in addition to their own. It was concluded that autologous blood donation is a safe and effective method of reducing potential complications in patients having elective open heart surgery.

Surgery, Heart, Hepatitis, Heart surgery

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Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy

Article Abstract:

While the world's blood supply is generally considered safe, and is becoming safer, there is obvious merit in donating blood that can be stored and used during an operation for individuals undergoing elective surgery. Often the volume of blood requested by surgeons for orthopedic surgery was 4 or more units of blood. The ability of 47 adults who were to undergo elective orthopedic surgery to provide adequate reserves of their own blood was studied. Patients were divided into two groups: one receiving erythropoietin, and a control group receiving an inactive placebo. Erythropoietin is a naturally occurring hormone that stimulates the hematopoietic stem cells of the body to produce blood. Both groups received therapeutic doses of iron as iron sulfate. Erythropoietin or placebo was given twice a week for 3 weeks; blood was collected during this period. The patients were able to give blood until the level of packed red cells fell below 34 percent (the hematocrit). The group which received erythropoietin produced an average of 5.4 units of blood, compared with 4.1 units for the placebo group. The individual red blood cells of the erythropoietin group were also an average of 41 percent larger and could therefore be expected to carry more oxygen than those in the placebo group. The erythropoietin utilized was produced by recombinant genetic engineering. The results indicate that recombinant erythropoietin can be used to reduce or eliminate the need for homologous transfusions, i.e. transfusions from others. This study should be considered preliminary and additional studies of more patients will be required to confirm the usefulness of this technique.

Research, Evaluation, Blood collection and preservation, Erythropoietin, Erythropoiesis

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Strategies for the review of transfusion practices

Article Abstract:

Several new methods have been developed recently in an attempt to more carefully screen blood to minimize transfusion- associated diseases. Increased awareness of the transmission of the human immunodeficiency virus (HIV), the virus thought to be responsible for the development of AIDS (acquired immunodeficiency syndrome), through the transfusion of blood has prompted some peer review committees in health facilities to monitor more closely the appropriateness of transfusions. Transfusion policies differ from one institution to another according to the types of patients treated and the availability of blood products and supporting laboratory services. Despite this variation in levels of need and usage, it is recommended that all health care institutions establish specific criteria for developing and auditing procedures to determine when therapeutic transfusions should be administered. Because of the relatively recent increase in concern regarding the HIV infection, many healthcare facilities have not yet developed new guidelines to respond to it. It is suggested that more specific indications and audit criteria be developed for each type of blood component that is transfused and that any areas of controversy be examined. A method for assessing the need for transfusion should be clearly outlined and all health care professionals should be made aware of the procedures to achieve a more thorough and more coordinated effort in preventing unnecessary blood transfusions.

Management, Laws, regulations and rules, Testing, HIV (Viruses), HIV, Blood transfusion, Joint Commission on Accreditation of Healthcare Organizations

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