Blood management and radical retropubic prostatectomy: Quebec experience

One of the concerns of patients undergoing radical retropubic prostatectomy (RRP) is the risk of intraoperative bleeding and the subsequent need of blood products. Patients can presently consider pre-operative autologuous blood donation (PAD) prior to elective urological oncology surgery to decrease the risk of allogenic transfusion. We reviewed the medical charts of 141 patients that had a RRP in the CHUQ-Pavillon Hôtel-Dieu de Québec in 1996 for prostate cancer. The average and median blood loss were respectively 804 cc and 650 cc, but more than 75% of patients lost less than 1,000 ml. Allogeneic transfusion was required in 11 (7.8%) patients. PAD was done in 45.4 %. The clinical characteristics of patients with PAD were similar to the patients who did not bank blood. The need for allogeneic transfusion was reduced to 3% (2/64) in the patients with PAD compared to 11.7% for the 77 patients without PAD. The average blood loss was higher in the 11 patients that received allogenic blood (1641 cc vs 734 cc, p < 0.01), but their average preoperative Hb was lower (127.9 vs 141.9, p < 0.01). These results suggest that there may be other effective methods in preventing the need for allogenic blood transfusion in RRP.