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Published on: September 15, 2023
[Preoperative autologous blood donation in coronary artery bypass grafting in elderly patients]
M Hibi1, H Ohshima, F Murakami
1Department of Surgery, Aichi Prefectural Owari Hospital, Ichinomiya, Japan.
Insights
Preoperative autologous blood donation using epoetin alpha is not effective in reducing allogeneic blood transfusions for elderly patients undergoing coronary artery bypass grafting (CABG). This approach did not significantly lower transfusion risks in this demographic.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Geriatric Medicine
Context:
- Allogeneic blood transfusions carry inherent risks, including transfusion reactions and infections.
- Coronary artery bypass grafting (CABG) is increasingly performed in elderly patients.
- Preoperative autologous blood donation (PAD) aims to mitigate risks associated with allogeneic transfusions.
Purpose:
- To evaluate the efficacy of preoperative autologous blood donation (PAD) combined with subcutaneous epoetin alpha in patients undergoing elective coronary artery bypass grafting (CABG).
- To compare the outcomes of PAD in elderly patients (over 65 years) versus younger patients (under 64 years) undergoing CABG.
- To assess the impact of PAD on postoperative bleeding and the need for allogeneic blood transfusions in different age groups.
Summary:
- The study compared 18 elderly patients (>65 years) with 20 younger patients (<64 years) undergoing CABG, utilizing preoperative autologous blood donation (800-1,200 g) with epoetin alpha.
- Elderly patients exhibited significantly greater postoperative bleeding and required larger quantities of allogeneic blood transfusions compared to the younger group (p < 0.05).
- The incidence of allogeneic blood usage was also significantly higher in the elderly cohort (p < 0.05).
Impact:
- Preoperative autologous blood donation with epoetin alpha appears to be less effective in reducing allogeneic blood transfusions for elderly patients undergoing CABG.
- The findings suggest that PAD may not adequately mitigate the risks of transfusion reactions or infections in the elderly population undergoing this procedure.
- This study highlights the need for alternative strategies to optimize transfusion management in older adults undergoing cardiac surgery.
Abstract:
Allogeneic blood transfusion still carries risks of transfusion reaction and infection. We examined the effect of a preoperative autologous blood donation (800-1,200 g) by subcutaneous epoetin alpha injection on a series of patients undergoing elective coronary artery bypass grafting (CABG). CABG was being performed with increased frequency in elderly patients. We have performed CABG in 18 patients over 65 years of age (elderly group). These patients were compared with 20 patients under 64 years of age (younger group). Postoperative bleeding and allogeneic blood transfusion were significantly larger in quantity in the elderly group than the younger group (p < 0.05). The incidence of allogeneic blood usage was significantly higher in the elderly group than the younger group (p < 0.05). Therefore, a preoperative autologous blood donation in CABG was considered to be not so effective for saving allogeneic blood transfusion and preventing transfusion reaction or infection in elderly patients.
