[Differed autologous blood transfusion and its effects during pulmonary lobectomy]

The aim of our study was to determine the value of preoperative autologous blood donation and its importance with regard to pulmonary lobectomies. Over the course of three years and a total number of 220 operations, autologous blood was preoperatively deposited in 74 cases. 21 patients did not meet the criteria for autologous blood donation and were excluded from the study. It was found that only 6.8% of the patients who had donated autologous blood required a homologous blood transfusion versus 27.2% in the non-donor group. This would imply, that the necessity for homologous blood transfusion is reduced by approximately 75% in patients depositing autologous blood prior to surgery. While we observed similar haemoglobin levels in both groups at admission, it was found that autologous blood donors went into surgery with an Hb 1.5 g% lower than non donors; the levels however adjusted themselves immediately postoperatively. No increased complication rate was found as a result of preoperative autologous blood donation. The data indicate that only 30% of patients undergoing pulmonary lobectomy require homologous blood transfusions. 80% of these patients could benefit from preoperative autologous blood donation. For 70% of all patients the procedure would be of no benefit. Bearing in mind the immunosuppressive effect of homologous blood transfusions, which may result in a higher rate of tumor recurrence, we find preoperative autologous blood donation a justifiable procedure even under these circumstances. It would however be beneficial if studies were conducted to investigate to what extent similar results could be achieved by preoperative acute isovolemic hemodilution.