[Prescribing and performing autologous blood transfusion: experience at a University Medical Center]

Prescription and carrying out of autologous blood transfusion in a university hospital during a whole year (1992) were investigated. 554 patients were involved. 88% of them gave at least one blood unit. Three surgical groups are specified: cardiac surgery with bypass (95 patients), orthopaedic procedures with knee or hip replacement or spine surgery (276 patients) and other types of surgery (117 patients). Prescriptions of blood donation before cardiac surgery were not carried out (by the transfusion centre) twice more often than in the other groups. This is why autologous blood taking is now effected in the anaesthetic unit. 88.9% (n = 434) of all patients did not receive homologous blood (90% in the orthopaedic group, 84% in the cardiac group). 25% of the collected units were not transfused. This figure is only 8% for the cardiac patients. An efficiency index is suggested taking in account the transfusion of autologous blood units and the need of homologous transfusion: % autologous used units x % procedures realized without homologous blood. The good rate to achieve could be 70%. In aorto-coronary bypass surgery when no autologous blood was collected preoperatively, 57.5% patients received homologous blood vs 16% when at least one unit was predeposited. A short review of literature shows an increasing place of predeposited autotransfusion, with some limits in orthopaedic surgery where a combination of autologous blood donation and other erythrocytes saving methods appears to give the best results. Erythropoietin, critical haemoglobine concentration threshold, autologous transfusion in cancer patients still need further studies.