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[Preoperative autologous blood donation with cardiac surgery]
M Yoda1, M Nonoyama, T Shimakura
1Department of Cardiovascular Surgery, Fukuyama Circulation Hospital, Fukuyama, Japan.
Insights
Preoperative autologous blood donation effectively reduces homologous blood transfusions in cardiac surgery. Donating 800 ml is often sufficient, but 1,200 ml is recommended for complex procedures like redo operations or combined bypass and valve surgery.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Context:
- Preoperative autologous blood donation (PAD) is a common strategy to mitigate risks associated with allogeneic blood transfusions in elective cardiac surgery.
- Determining the optimal volume of predonated blood is crucial for maximizing transfusion avoidance while minimizing patient burden.
Purpose:
- To evaluate the efficacy of varying volumes of autologous blood predonation in preventing the need for homologous blood transfusions during different types of cardiac surgical procedures.
- To establish guidelines for the volume of autologous blood donation required to avoid allogeneic transfusions based on surgical complexity.
Summary:
- This study compared outcomes for 128 patients undergoing cardiac procedures with different volumes of autologous blood predonation (400 ml and 800 ml without cardiopulmonary bypass; 800 ml and 1,200 ml with cardiopulmonary bypass).
- Results showed that 800 ml predonation without cardiopulmonary bypass (CPB) achieved 100% avoidance of homologous transfusions, compared to 63.6% with 400 ml.
- For procedures with CPB, 1,200 ml predonation resulted in a 94.4% avoidance rate, versus 86.1% with 800 ml, with higher transfusion needs in redo operations or combined CABG + valve replacement.
Impact:
- Findings suggest that 800 ml of predonated autologous blood may be sufficient to avoid homologous transfusions in many cardiac surgeries.
- A predonation volume of 1,200 ml is advisable for patients undergoing more complex procedures, such as redo operations or combined coronary artery bypass grafting and valve replacement.
- This research aids in optimizing autologous blood donation protocols, potentially reducing transfusion-related risks and costs in cardiac surgery.
Background:
Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The purpose of this study was to ascertain how much volume of predonated autologous blood need to avoid of homologous blood transfusion in cardiac procedure.
Methods:
One hundred twenty-eight patients underwent scheduled cardiac procedure between January 1998 and December 1999. Group 1: 400 ml predonated, operation without cardiopulmonary bypass (CPB) [n = 33], group 2: 800 ml predonated, operation without CPB (n = 23), group 3: 800 ml predonated, operation with CPB (n = 36), group 4: 1,200 ml predonated, operation with CPB (n = 36). Surgical procedures underwent only off-pump coronary artery bypass grafting (OPCAB) in groups 1 and 2. In groups 3 and 4 included coronary artery bypass grafting (CABG), valve replacement, CABG + valve replacement and atrial septal defect repair.
Results:
There were no significant differences in mean body weight, mean preoperative hematocrit values or mean volume of intraoperative blood loss between groups 1 and 2. There were no significant differences in mean age, mean body weight, mean preoperative and postoperative day-7 hematocrit values, mean volume of intraoperative blood loss or mean CPB time between groups 3 and 4. The mean postoperative day-7 hematocrit value was significantly lower in group 1 than in group 2. Homologous blood transfusion was avoided in 63.6% of those with predonation of group 1 versus 100% at group 2 (p < 0.05), 86.1% at group 3 versus 94.4% at group 4 (p < 0.05). In group 3, all patients who underwent redo operation or CABG + valve replacement needed homologous blood transfusion.
Conclusions:
Autologous blood transfusion is effective for reducing the homologous blood requirement. It also seems that predonation of 800 ml may be sufficient to avoid homologous blood transfusion in cardiac surgery, however predonation of 1,200 ml is desirable in cases of redo operation or CABG + valve replacement.