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[Autologous blood transfusion in cardiac surgery over 70-year-old patients]
1Division of Cardiovascular Surgery, Aomori City Hospital, Japan.
Insights
Older cardiac surgery patients struggle with preoperative autologous blood donation due to anemia. Autologous plasma donation offers a safe alternative for these elderly individuals, acting as a postoperative volume expander.
Area of Science:
- Geriatric Medicine
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Autologous blood transfusion is preferred but faces challenges in elderly patients undergoing cardiac surgery.
- Preoperative autologous blood donation (PABD) is often unsuccessful in patients over 70 due to pre-existing anemia.
Purpose of the Study:
- To investigate the feasibility and outcomes of PABD in elderly cardiac surgery patients compared to younger counterparts.
- To explore alternative autologous blood component donation strategies for elderly patients.
Main Methods:
- Comparison of PABD success rates and donated blood volumes between patients over 70 and younger patients.
- Assessment of iron status, reticulocyte counts, and erythropoietin levels to evaluate erythropoiesis.
- Evaluation of autologous plasma donation using a membranous plasma separator.
Main Results:
- Only 25% of elderly patients could complete PABD, yielding a mean of 355g whole blood, versus 96% in younger patients (mean 757g).
- Elderly patients showed higher erythropoietin levels but similar reticulocyte counts, indicating impaired bone marrow erythropoiesis.
- All elderly patients required homologous blood transfusions perioperatively.
- Autologous plasma donation was safe and did not alter circulatory indices, proving useful as a postoperative volume expander.
Conclusions:
- Elderly cardiac surgery patients have significantly reduced capacity for PABD due to impaired erythropoiesis.
- Homologous blood transfusion is frequently necessary for elderly patients undergoing cardiac surgery.
- Autologous plasma donation presents a viable and safe alternative for volume replacement in this patient group.
Abstract:
We discussed the problems for autologous blood transfusion particularly in the preoperative blood donation about the patients over 70-year-old who underwent cardiac surgery in contrast with the younger patients. Following results were obtained: 1) Because aged patients have the tendency of anemia before predonation, full storage of blood donation could not be successed. 2 of 8 over 70-year-old patients were able to do the preoperative phlebotomy, and their mean volume were 355 gram as whole blood. On the other hand, 96% patients in younger group were phlebotomized preoperatively, and their mean value of storaged blood volume were 757 gram. 2) As the examinations about the iron-related parameters, not all aged patients were iron deficiency status. Their reticulocyte counts were nearly equal level to the younger group and plasma concentration of erythropoietin were higher in the aged patients than that in the younger group. These results indicate that erythropoiesis in the bone marrow was deteriorated in the aged patients. 3) In aged patients, all of them were required homologous blood transfusion at their perioperative terms. We thought that they have had the anemia before preoperation and our tolerable, allowable level to the postoperative anemia was not lower in the aged patients as against to the younger group. 4) We performed the autologous plasma donation with the membranous plasma separator added to the whole blood donation. It was easy and safe method, and circulatory indices were not changed before and after plasma-separation even in the aged patients. These autologous plasma were usefully administered as the volume expander postoperatively.