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Efficiency and safety of preoperative autologous blood donation in cardiac surgery: a matched-pair analysis in 432
Klaus Martin1, Emanuel Keller, Ralph Gertler
1Institute of Anaesthesiology, German Heart Centre, Clinic at the Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany. martin@dhm.mhn.de
Insights
Preoperative autologous blood donation (PABD) significantly reduces the need for allogeneic blood products in adult cardiac surgery. This study found PABD to be a safe and effective alternative to allogeneic transfusions.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Blood Banking
Background:
- Global blood product shortages necessitate strategies to reduce reliance on allogeneic transfusions.
- Preoperative autologous blood donation (PABD) is a potential method to mitigate this shortage in cardiac surgery.
- Assessing the safety and efficacy of PABD programs is crucial for clinical implementation.
Purpose of the Study:
- To evaluate the safety and efficiency of a PABD program in adult cardiac surgery.
- To compare the need for allogeneic blood products between autologous blood donors and matched non-donors.
- To analyze adverse events associated with PABD.
Main Methods:
- A matched-pair analysis comparing patients undergoing cardiac surgery who donated autologous blood with non-donors.
- Matching criteria included age, weight, BMI, sex, hemoglobin, EuroSCORE, antifibrinolytic therapy, and bleeding risk.
- Analysis of adverse events during donation, perioperative data, hemoglobin levels, and allogeneic blood transfusion requirements.
Main Results:
- No major adverse cardiac events or deaths occurred in the PABD group during the donation process.
- Significant reductions in the use of packed red cells, fresh frozen plasma, and platelets were observed in the PABD group compared to controls.
- No transfusion-related side effects were reported, and postoperative hemoglobin levels were similar between groups.
Conclusions:
- PABD is a safe and effective strategy to decrease allogeneic blood product utilization in adult cardiac surgery.
- Risk stratification is not necessary for PABD in carefully selected patient cohorts.
- PABD serves as a viable alternative to allogeneic transfusions, enhancing blood resource management.
Objective:
A shortage of blood products is predicted for the near future in many countries all over the world. Preoperative autologous blood donation (PABD) in cardiac surgery is considered an option to reduce the need of allogeneic blood products. We analysed a 1-year period of our institutional database according to the safety and efficiency of our autologous blood donation programme.
Methods:
All patients who donated autologous blood prior to cardiac surgery were matched to a non-donor according to age, body weight, body mass index, sex, haemoglobin concentration, EuroSCORE, antifibrinolytic therapy and risk for bleeding. We analysed the occurrence of adverse effects during donation in all donors as well as the main perioperative data, haemoglobin levels and the need for allogeneic blood transfusion in all patients.
Results:
There were no major cardiac events such as myocardial infarction, worsened cardiac insufficiency or death in the donor group during the PABD process. A total of 216 patients could be matched. Exposure to allogeneic blood products was significantly reduced in the donor group (packed red cells 70 patients (pts) vs 118 pts (p<0.001), fresh frozen plasma 26 pts vs 54 pts (p=0.001), platelets 10 pts vs 22 pts (p=ns)). There were no reports of transfusion-related side effects. Further, there was no difference in haemoglobin concentrations at postoperative day 1 and at discharge.
Conclusions:
In this large matched-pair analysis without the need for risk stratification, PABD reduces the need for allogeneic blood products in adult cardiac surgery. In a carefully selected cohort, PABD is a safe and efficient alternative to allogeneic transfusion.
