Preoperative autologous plasmapheresis--9 years experience in orthopedic surgery

Since nine years preoperative autologous plasmapheresis (PPH) is an essential part of a comprehensive autologous transfusion program in the Rehabilitation Hospital/Orthopedic University Clinic of Ulm. After v. Finck's recommendation in 1984 we started plasma-predeposit by centrifugation-plasmapheresis (PCSR, Haemonetics Comp.) in all elective orthopedic-surgical patients expecting a blood loss > 1,000 ml. Primarily this procedure was used for intra- and postoperative hemostasis stabilization and for having the ideal component to recomplete the harvested red cells by the Cell SaverR to full blood units. By clinical experience the strategy of routinely combining plasma-predeposit and wound-blood salvaging instead of full blood- or red cell's-predeposit was recognized as not only being highly effective in saving of banked blood but furthermore as being the best way of getting free from all time related problems due to the limited preservation period of red cells because donated platelet poor plasma (PPP) can easily be frozen and stored up to one year at least. In addition there is one more decisive aspect in favour of autologous fresh frozen plasma (AFFP): it may be used for the best and most physiological kind of volume replacement. In combination with a short acting artificial plasma substitute (e.g. Polygelin) for intraoperative replacement AFFP is best suitable for reestablishing and maintaining postoperative normovolemia which is essential for any kind of hemodilution practicing like we routinely do when accepting low hemoglobin concentrations (> 7,0 g/dl) to avoid homologous blood transfusions and to reduce the risk of thromboembolic complications at the same time.(ABSTRACT TRUNCATED AT 250 WORDS)