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[Predonation and transfusion in open heart surgery]
H Minami1, N Wakita, T Kawahira
1Department of Cardiovascular Surgery, Kobe Rosai Hospital, Japan.
Insights
Autologous blood predonation significantly reduces the need for homologous blood transfusions in open-heart surgery. Predonating 800 ml of autologous blood may eliminate the need for homologous transfusions.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Open-heart surgery frequently requires blood transfusions, increasing risks and costs.
- Autologous blood predonation is a strategy to mitigate homologous blood use.
Purpose of the Study:
- To evaluate the efficacy of autologous blood predonation in reducing homologous blood transfusions during open-heart surgery.
Main Methods:
- A prospective study of 100 open-heart surgeries (CABG, valve, ASD, myxoma) was conducted.
- Inclusion criteria for autologous predonation: age < 70, weight > 40 kg, hemoglobin > 12 g/dl.
- Exclusion criteria: NYHA class IV, emergency operations.
Main Results:
- Only 36.6% of patients with autologous predonation required homologous transfusions, compared to 63.4% without.
- Homologous transfusion rates were 5% for 800 ml predonation, 69% for 400 ml, and 71% for 200 ml.
- Blood loss was not significantly dependent on sex or age.
Conclusions:
- Autologous blood predonation is effective in reducing homologous blood requirements for open-heart surgery.
- Predonation of 800 ml appears sufficient to avoid blood transfusions in many open-heart procedures.
Abstract:
The efficacy of predonation of autologous blood in reducing the use homologous blood during open heart surgery was investigated. Between January 1997, and February 1998, predonation and transfusion was studied in 100 consecutive open heart operations (CABG, 77; valve surgery, 17; ASD, 5; myxoma, 1). The guidelines for autologous predonation were as follows: an age < 70 years, a weight > 40 kg and a hemoglobin > 12 g/dl. Patients in NYHA class IV or undergoing emergency operation were excluded. The blood loss during operation ranged from 195 to 1,850 ml (mean; 670 ml), being from 305 to 1,850 ml (723 ml) for CABG, from 260 to 1,020 ml (493.5 ml) for valve surgery and from 195 to 570 ml (342 ml) for ASD. The blood loss was not significantly dependent on sex or age and did not differ elective and emergent operations. Only 36.6% of patients with autologous predonation needed homologous transfusion versus 63.4% of those without predonation. Homologous transfusion was done in only 5% of the those with predonation of 800 ml versus 69% at 400 ml and 71% at 200 ml. In conclusion, autologous blood transfusion is effective for reducing the homologous blood requirement. It also seems that predonation of 800 ml may be sufficient to allow open heart surgery without blood transfusion.