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[Autologous blood donation and transfusion in cardiosurgical high risk patients (author's transl)]
Insights
Preoperative autologous blood collection can significantly reduce the need for homologous blood transfusions in cardiovascular surgery. This method is safe and effective, potentially enabling half of all patients to avoid allogeneic blood.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Context:
- Cardiovascular operations often necessitate homologous blood transfusions.
- Risks associated with allogeneic blood transfusions are a significant concern.
- Autologous blood collection is a potential alternative to minimize homologous blood use.
Purpose:
- To evaluate the feasibility and efficacy of long-term preoperative autologous blood collection combined with oxygenator hemodilution in cardiovascular surgery patients.
- To assess the impact of autologous blood donation on the requirement for homologous blood.
- To determine the safety and patient acceptance of preoperative autologous blood donation.
Summary:
- A mean of 2.5 units of autologous blood was collected preoperatively, with men donating more than women.
- Autologous blood collection reduced homologous blood requirements by 50% overall and 70% in atrial septal defect (ASD) cases.
- The percentage of patients not requiring homologous blood increased from 3% to 25% overall and 13% to 67% in ASD cases.
Impact:
- Preoperative autologous blood donation can enable approximately half of cardiovascular surgery patients to avoid homologous blood transfusions.
- Early initiation of autologous donation programs and iron substitution can further improve outcomes.
- For ASD and valve replacement surgeries, adequate autologous blood collection should be standard practice due to transfusion risks.
Abstract:
In an unselected group of patients undergoing a wide variety of cardiovascular operations, the possibilities of long-term preoperative autologous blood collection combined with oxygenator hemodilution were examined. The mean number of preoperative donations was 2.5 units of blood. It was 50 p.c. higher in men than in women. One third of the men, but no female patient, collected 4-5 units of autologous blood, thus equalling the mean calculated blood requirements. Short- or long-term disavantages of the donations were not seen. --The total amount of homologous blood required could be diminished by 50 p.c., in atrial septal defects even by 70 p.c. The percentage of patients without homologous blood increased from 3 to 25 p.c. of the total material, but in atrial septal defects from 13 to 67. Further improvements of these values may be expected from an earlier entry into the program of autologous donations and, correspondingly, by an earlier iron substitution. Only thus, without special methods of storage, roughly calculated one half of all cardiovascular surgical patients may come through without homologous blood. In view of the risks of homologous blood transfusion, already now no atrial septal defect and, with limitations, no valve replacement should come to surgery without adequate autologous blood collection.