The use of autologous blood: The National Blood Resource Education Program Expert Panel

Article Abstract:

Concern about transmission of disease during blood transfusions has increased the interest in autologous transfusion, the use of the patient's own blood that is previously collected. In contrast, homologous transfusions use blood from volunteer donors. While homologous blood is now carefully screened for human immunodeficiency virus (HIV) and hepatitis, autologous blood transfusion is still safer for certain patients. The likelihood of the need for transfusion during surgery can be predicted by the type of surgical procedure; most operations do not necessitate blood transfusions. Autologous blood should only be stored for patients who are likely to need a transfusion. Three forms of autologous transfusion exist. The first method, preoperative autologous blood donation, is a series of donations made before planned surgery. Blood collection is usually performed once a week, starting four to six weeks prior to surgery, but can begin as late as two weeks before the operation. Patients who will have elective orthopedic surgery, such as a hip replacements, are ideal candidates for this procedure because the operation can be safely delayed to allow for autologous donation. In contrast, some surgeries should not be delayed, such as cardiac surgery in unstable patients. Both elderly patients and children as young as eight years old can donate autologous blood if their medical condition is satisfactory. The second autologous technique is perioperative blood salvage, the collection and reinfusion of blood lost during and immediately after surgery. Approximately 50 percent of the lost blood can often be salvaged. The third option is acute normovolemic hemodilution, which involves removal of blood just before surgery, replacement with fluids to maintain blood volume, and reinfusion of the blood after the operation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Blood collection and preservation, Safety and security measures, Blood transfusion, Autologous, Autologous blood transfusion, Blood banks

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Anaesthesia and major noncardiac surgery

Article Abstract:

The high incidence of unrecognized cardiac ischemia is becoming more important as our population ages and surgery must be performed on higher risk patients. Cardiac ischemia occurs when the blood supply to the heart is reduced. Postoperative risk factors include evidence of heart failure, recent heart attack, preoperative cardiac arrhythmias, type of surgery, poor general condition, heart valve disorders, and age over 70 years. The more risk factors, the greater the risk of complications following elective surgery. The risk of complications can be determined by evaluating the patient for major risk factors and examining the results of preoperative electrocardiographs. Vasodilators, beta adrenergic blockers, anticoagulants or platelet-active drugs, coronary bypass surgery or angioplasty might reduce cardiovascular complications following general surgery.

Editorial, General anesthesia

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Iron supplementation after femoral head replacement for patients with normal iron stores

Article Abstract:

It may be unnecessary to give patients iron supplements after surgery to replace hemoglobin depleted through blood loss if their iron stores are adequate. Seventy-nine patients who had hip replacement surgery were followed for at least two weeks. Analysis of bone removed during surgery showed that all had normal iron stores. Thirty-seven were given 325 milligrams of ferrous (iron) sulfate four times a day, while forty-two received no supplement. Complete blood counts (CBC) were done every 2 to 3 days, and reticulocyte fractions every 4 to 5 days. Both groups regained over 80% of their hemoglobin after the first week, and both experienced a similar increase in reticulocyte fraction, a measure of red blood cell synthesis.

Health aspects, Iron, Iron (Metal)

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