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Autologous blood donation before elective off-pump coronary artery bypass grafting
Masataka Yoda1, Masaki Nonoyama, Tadayuki Shimakura
1Department of Cardiovascular Surgery, Fukuyama Circulation Hospital, 1-26 Sumiyoshi-cho, Fukuyama, Hiroshima 720-0809, Japan.
Insights
Donating 800 ml of autologous blood before off-pump coronary artery bypass grafting (CABG) effectively eliminated the need for homologous blood transfusions. A 400 ml donation was less successful in avoiding transfusions.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Preoperative autologous blood donation is a strategy to minimize homologous blood exposure.
- Cardiac surgery, particularly off-pump coronary artery bypass grafting (CABG), carries a risk of requiring allogeneic blood products.
Purpose of the Study:
- To determine the optimal volume of autologous blood predonation required to obviate homologous blood transfusion in scheduled off-pump CABG.
- To evaluate the efficacy of different autologous blood donation volumes in avoiding allogeneic transfusions.
Main Methods:
- A cohort of 56 patients undergoing scheduled off-pump CABG were divided into two groups.
- Group 1 (n=33) donated 400 ml of autologous blood, while Group 2 (n=23) donated 800 ml, at a rate of 400 ml/week.
- All patients received an equivalent volume of saline solution post-donation.
Main Results:
- No significant differences were observed in patient demographics, preoperative hematocrit, graft numbers, or intraoperative blood loss between the groups.
- Group 2 demonstrated a significantly higher mean postoperative day-7 hematocrit (39.3% vs 33.6%).
- The rate of avoiding homologous blood transfusion was 100% in the 800 ml group (Group 2) compared to 63.6% in the 400 ml group (Group 1).
Conclusions:
- An 800 ml autologous blood predonation is sufficient to avoid homologous blood transfusion in patients undergoing scheduled off-pump CABG.
- Autologous blood donation is an effective method for reducing the need for allogeneic blood products in this surgical population.
- Patients with cardiovascular disease undergoing CABG should receive saline concurrently with autologous blood donation.
Purpose:
Preoperative autologous blood donation reduces exposure to homologous blood transfusions in cardiac surgery. The purpose of this study was to ascertain the volume of predonated autologous blood needed to avoid homologous blood transfusion in scheduled off-pump coronary artery bypass grafting (off-pump CABG).
Methods:
Fifty-six patients underwent scheduled off-pump CABG between January 1999 and December 2000. These patients all donated either 400 ml (group 1, n = 33) or 800 ml (group 2, n = 23) of autologous blood before operation. These patients donated at a rate of 400 ml per week. All patients were given an equal volume of saline solution at the time of autologous donation.
Results:
There were no significant differences in the mean age, mean body weight, mean preoperative hematocrit values, mean graft number, or mean volume of intraoperative blood loss between groups 1 and 2. There was a significant difference in the mean postoperative day-7 hematocrit value (33.6% +/- 1.3% vs 39.3% +/- 1.3%, P << 0.05). The rates of avoiding homologous blood transfusion were 63.6% in group 1 and 100% in group 2 ( P << 0.05).
Conclusions:
Autologous blood transfusion is effective for reducing the homologous blood requirement. We believe that an 800-ml predonation is sufficient to avoid homologous blood transfusion in scheduled off-pump CABG; furthermore, patients with cardiovascular disease, including severe coronary artery disease, should be administered saline along with the blood donation.
