Related Experiment Videos
[Quality assurance in autologous blood collection from critically ill patients]
H Kiesewetter1, F Jung, J Koscielny
1Abteilung für Klinische Hämostaseologie und Transfusionsmedizin, Universität des Saarlandes, Homburg/Saar, BRD.
Insights
Quality controls for autologous blood collection in critically ill patients are crucial. Careful patient assessment and monitoring are essential to mitigate risks like clinical deterioration during autohemotherapy.
Area of Science:
- Medical Science
- Hematology
- Critical Care Medicine
Background:
- Autologous blood collection in critically ill patients requires stringent quality controls.
- European guidelines, AMG, and GMP regulations define product control standards.
- Vagotonic or hypertensive crises occur in 10-15% of cardiosurgical patients during blood collection.
Purpose of the Study:
- To outline quality control measures for autologous blood collection in critically ill patients.
- To assess the risks and benefits of autohemotherapy in specific patient populations.
- To evaluate patient clinical condition monitoring during blood collection.
Main Methods:
- Review of European guidelines, AMG, and GMP regulations for product control.
- Clinical monitoring of critically ill patients, including those with critical vascular disease and tumors.
- Utilizing exercise tests (bicycle ergometer, treadmill, stair climbing) to assess patient condition before and after blood collection.
Main Results:
- Autohemotherapy was administered to only 25% of cardiosurgical patients (40% with aortocoronary venous bypass).
- 20% of patients undergoing autohemotherapy showed clinical deterioration during blood collection.
- Clinical benefit of autohemotherapy in tumor patients is not clearly demonstrated, but recommended if curative therapy is possible.
Conclusions:
- Comprehensive quality control, encompassing products, collection, and patient monitoring, is vital for autologous blood procedures.
- Simple exercise tests can effectively monitor patient clinical status during blood collection.
- Risk-benefit assessment is crucial, especially for vulnerable groups like cardiosurgical patients and those with tumors.
Abstract:
Quality controls of autologous blood collections in critically ill patients comprise the control of blood products, blood collection, and of the patients themselves. The control of products is defined in European guidelines, the AMG (law governing the manufacture and prescription of medicine) and GMP regulations. The products are described in the monograph of the Federal Health Office. The quality control of blood collection in patients with a critical vascular disease is important since vagotonic or hypertensive crises may occur frequently (in 10-15% of cardiosurgical patients). The quality control of the critically ill patients themselves is important in order to be able to balance benefits against risks. A phlebotomy of 500 ml may lead to a considerable deterioration of the clinical condition. The clinical condition can be controlled by simple exercise tests prior to and after the blood collection (bicycle ergometer, treadmill or climbing stairs). In our own investigations only about 25% of cardiosurgical patients (40% of patients with aortocoronary venous bypass) received autohemotherapy, and 20% of them showed a clinical deterioration during the phase of blood collection. Other problematic patients are those suffering from a tumor. A clear clinical benefit of autohemotherapy in these patients has not been demonstrated up to now; nevertheless, when a curative therapy is possible, they should be treated with autohemotherapy.