A Prospective Randomized Comparison of Three Blood Conservation Strategies for Radical Prostatectomy 

1999 ◽  
Vol 91 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Terri G. Monk ◽  
Lawrence T. Goodnough ◽  
Mark E. Brecher ◽  
John W. Colberg ◽  
Gerald L. Andriole ◽  
...  
Keyword(s):  
Blood Donation ◽  
Autologous Blood ◽  
Subcutaneous Administration ◽  
Radical Retropubic Prostatectomy ◽  
Allogeneic Blood ◽  
Conservation Strategies ◽  
Blood Conservation ◽  
Preoperative Autologous Blood Donation ◽  
Conservation Costs ◽  
Preoperative Autologous Donation

Background Preoperative autologous blood donation is a standard of care for elective surgical procedures requiring transfusion. The authors evaluated the efficacy of alternative blood-conservation strategies including preoperative recombinant human erythropoietin (rHuEPO) therapy and acute normovolemic hemodilution (ANH) in radical retropubic prostatectomy patients. Methods Seventy-nine patients were prospectively randomized to preoperative autologous donation (3 U autologous blood); rHuEPO plus ANH (preoperative subcutaneous administration of 600 U/kg rHuEPO at 21 and 14 days before surgery and 300 U/kg on day of surgery followed by ANH in the operating room); or ANH (blinded, placebo injections per the rHuEPO regimen listed previously). Transfusion outcomes, perioperative hematocrit levels, postoperative outcomes, and blood-conservation costs were compared among the three groups. Results Baseline hematocrit levels were similar in all groups (43%+/-2%). On the day of surgery hematocrit decreased to 34% +/-4% in the preoperative autologous donation group (P < 0.001), increased to 47%+/-2% in the rHuEPO plus ANH group (P < 0.001), and remained unchanged at 43%+/-2% in the ANH group. Allogeneic blood exposure was similar in all groups. The rHuEPO plus ANH group had significantly higher hematocrit levels compared with the other groups throughout the hospitalization (P < 0.001). Average transfusion costs were significantly lower for ANH ($194+/-$192) compared with preoperative autologous donation ($690+/-$128; P < 0.001) or rHuEPO plus ANH ($1,393+/-$204, P < 0.001). Conclusions All three blood-conservation strategies resulted in similar allogeneic blood exposure rates, but ANH was the least costly technique. Preoperative rHuEPO plus ANH prevented postoperative anemia but resulted in the highest transfusion costs.

Personalized Approach to Define Transfusion Support to Surgical Patients

1998 ◽  
Vol 21 (6_suppl) ◽  
pp. 78-83 ◽  
Author(s):  
F. Mercuriali ◽  
G. Inghilleri ◽  
E. Biffi
Keyword(s):  
Blood Loss ◽  
Blood Donation ◽  
Autologous Blood ◽  
Clinical Status ◽  
Cost Effective ◽  
Standard Of Care ◽  
Allogeneic Blood ◽  
Preoperative Autologous Blood Donation ◽  
Transfusion Requirements ◽  
Personalized Approach

Preoperative autologous blood donation (PABD) is accepted as a standard of care to reduce the risk of allogeneic blood transfusion. However, autologous blood is considered more costly than allogeneic blood. PABD can be made more cost-effective by reducing the cost of collection and by avoiding overcollection of units. When MSBOS and SOPCAB are used to identify and exclude from PABD procedures associated with low transfusion requirements, and to define the number of units to be collected, the overall AB wastage is still around 15% (ranging from 6% to 15% for different surgical procedures). To optimize the PABD program we have developed a more personalized approach to define each patient's transfusion requirement based on the predicted blood loss in mL of RBCs, calculated per surgical operation in the previous 6-12 months, along with the blood loss that the patient can tolerate. The latter depends on the baseline circulating RBC mass and the RBC mass compatible with the patient's clinical and cardiocirculatory condition. To fulfill transfusion requirements for each patient the most effective strategy can be selected according to the type and time to surgery, PABD applicability; age and clinical status of the patients taking into account what each of the different techniques can provide in terms of volume of RBCs produced or conserved.

scholarly journals Transfusion of autologous blood

Medicina ◽  
2008 ◽  
Vol 44 (6) ◽  
pp. 482
Author(s):  
Audronė Veikutienė ◽  
Edmundas Širvinskas ◽  
Dalia Adukauskienė
Keyword(s):  
Blood Transfusion ◽  
Blood Donation ◽  
Autologous Blood ◽  
Allogeneic Blood Transfusion ◽  
Allogeneic Blood ◽  
Autologous Blood Transfusion ◽  
Donor Blood ◽  
Autologous Transfusion ◽  
Preoperative Autologous Blood Donation ◽  
Blood Salvage

Recently the use of allogeneic (donor) blood transfusion is widely accepted in the clinical practice. Despite of good quality and safety of preparation of allogeneic blood, there are some risks related with transfusion: hemolytic, febrile, and allergic reactions, transfusion related acute lung injury, negative immunomodulatory effect, transmission of infections diseases, dissemination and recurrence of cancer. This is why the indications for donor blood transfusion are restricted, so new safer methods are discovered to avoid or to decrease the heed for allogeneic blood transfusion. Nowadays, there is an increased interest in autologous blood transfusion as the most acceptable alternative to allogeneic blood transfusion. Autologous transfusion is the collection and reinfusion of the patient’s own blood (donor and recipient is the same person). Several types of autologous transfusion can be used: preoperative autologous blood donation, acute normovolemic hemodilution, intraoperative blood salvage, postoperative blood salvage. Neverless, autologous transfusion does not protect from all risks, it still remains the safest type of blood transfusion and is important in the strategy of blood conservation.

scholarly journals Revisiting Old Practices: More Restricted Indication of Preoperative Autologous Blood Donation in Healthy Bone Marrow Donors According to Baseline Hemoglobin Levels

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3819-3819
Author(s):  
Isadora Olenscki Gilli ◽  
Afonso Celso Vigorito ◽  
Bruno Deltreggia Benites
Keyword(s):  
Bone Marrow ◽  
Blood Donation ◽  
Conflicts Of Interest ◽  
Autologous Blood ◽  
Allogeneic Blood ◽  
Autologous Blood Donation ◽  
Roc Curve Analysis ◽  
Preoperative Autologous Blood Donation ◽  
Allogeneic Transfusion ◽  
Cutoff Points

Abstract Background: Despite the cost-effectiveness of preoperative autologous blood donation (PAD) having been intensely debated over the last decade (due to a significant reduction in the risk of transfusion-transmitted diseases), no consensus has been reached as to the risk-benefit status of PAD for healthy bone marrow donors. There is concern regarding the occurrence of pre-procedure anemia caused by the autologous donation itself, consequently increasing the risk of transfusion, and the possibility of unnecessary hospital costs in the case of donors with collected and non-transfused red blood cell concentrates (RBC). Thus, this study aimed to evaluate the changes in hemoglobin levels related to PAD in bone marrow donors followed at our institution and to seek a hemoglobin cutoff with a predictive power for the actual need for this procedure. Study Design and Methods: We conducted a retrospective study at the Hematology and Transfusion Medicine Center at the University of Campinas, Brazil, evaluating the data for all bone marrow donors registered at our institution between 2002 and 2016 who had donated at least one unit of autologous blood. Mean Hgb values were compared separately for donors who donated 1 or 2 units, at 3 time-points: before PAD collection, the morning before marrow harvest and soon after harvest. ROC curves were used to investigate possible Hgb cutoff points for prediction of transfusion requirement. Results: Donors identified in the study period comprised 80 individuals: 76 collected only 1 unit and 4 individuals collected 2 autologous units. Mean baseline Hgb values did not differ significantly between the 2 groups [1 unit: 14.9(12.3-18.1) x 2 units: 13.57 (12.6-14.8), p=0.069]. After PAD collection, there was a significant drop in Hgb levels for the whole cohort of donors [14.82 (12-18.1) x 12.75 (8.9-17.4), p<0.001], more pronounced for the group that donated 2 units (Hgb levels at this time point, 1 unit: 12.8(8.9-17.4) x 2 units: 11.55(11.2-12.1), p=0.045). However, after marrow harvest, Hgb levels were similar for the 2 groups, and despite significant declines in Hgb levels, none of the donors in our cohort required allogeneic transfusion and only 61.2% required autologous transfusion. To further evaluate the use of Hgb levels as a predictor for the efficacy of collecting autologous blood, ROC curve analysis identified baseline Hgb< 14.35g/dL as the sensitive cutoff to predict the need for transfusion after marrow harvest. These levels had a sensitivity of 52% and specificity of 80.4%, p=0.001 and OR=4.38 (95% confidence interval: 1.65-12.59). Conclusion: In the current era of Patient Blood Management, mechanisms that prevent allogeneic blood transfusions, such as PAD, must be explored and debated, since they reduce patient exposure to risks related to allogeneic blood. Our analysis demonstrates the possibility of using hemoglobin thresholds as cutoff points for indication of PAD, tending to a more cost-effective approach. Furthermore, despite significant declines in Hgb levels after PAD, none of the donors in our cohort required allogeneic transfusion, demonstrating the safety of this procedure. Thus, the indication of PAD remains an option for those donors who feel insecure despite higher baseline Hgb levels. Disclosures No relevant conflicts of interest to declare.

An Autologous Blood Donation Program for Paediatric Scoliosis Patients in Hong Kong

2002 ◽  
Vol 30 (6) ◽  
pp. 775-781 ◽  
Author(s):  
K. S. Lo ◽  
B. F. M. Chow ◽  
H. T. Chan ◽  
S. Gunawardene ◽  
K. D. K. Luk
Keyword(s):  
Blood Transfusion ◽  
Blood Donation ◽  
Autologous Blood ◽  
Allogeneic Blood Transfusion ◽  
Allogeneic Blood ◽  
Autologous Blood Donation ◽  
Corrective Surgery ◽  
Preoperative Autologous Blood Donation ◽  
Careful Patient ◽  
Retrospective Audit

A retrospective audit was conducted to determine the safety, efficacy and patient satisfaction related to a preoperative autologous blood donation program for children and teenagers undergoing corrective surgery for scoliosis. Forty-five of the 77 patients donated the requested amount of blood. These 45 compliant patients had been requested to donate fewer units of blood than noncompliant patients (mean 4.0 vs 4.6 respectively, P=0.02). Twelve patients required allogeneic blood transfusion. Two patients had surgery delayed making the collected autologous blood unavailable. The extent of the operation was associated with the need for allogeneic blood transfusion. Six and a half percent of all donated units of blood were discarded. No major complications were reported. Overall, 93% of patients were satisfied with the program. With careful patient selection, good inter-departmental coordination and teamwork, preoperative autologous blood donation in paediatric patients undergoing extensive corrective surgery for scoliosis is safe and effective.

Blood Conservation and Blood Salvage

1994 ◽  
Vol 9 (2) ◽  
pp. 86-97 ◽  
Author(s):  
Lawrence T. Goodnough ◽  
Mathew S. Bodner ◽  
Jeffrey W. Martin
Keyword(s):  
Blood Transfusion ◽  
Blood Donation ◽  
Autologous Blood ◽  
Autologous Blood Donation ◽  
Blood Conservation ◽  
Blood Safety ◽  
Preoperative Autologous Blood Donation ◽  
Relative Risks ◽  
Life Saving ◽  
Conservation Interventions

Autologus blood transfusion has been recommended as the blood of choice for surgical patients. Procurement of autologus blood can be accomplished by utilizing one or more conservation interventions: preoperative autologous blood donation, acute preoperative hemodilution, and perioperative autologous salvage. Recent estimates of cost-effectiveness emphasize that blood conservation interventions need to be held accountable with regards to their costs as well as their benefits. Despite recent advances in blood safety, patients need to be informed of the relative risks of blood transfusion and blood conservation, so that a careful balance of the need for blood conservation along with an acknowledgment of the life-saving properties of blood can be maintained.

Use of preoperative autologous blood donation in patients undergoing radical retropubic prostatectomy

Urology ◽  
1999 ◽  
Vol 54 (1) ◽  
pp. 130-134 ◽  
Author(s):  
Jerome F O’Hara ◽  
Juraj Sprung ◽  
Eric A Klein ◽  
John A Dilger ◽  
Ronald E Domen ◽  
...  
Keyword(s):  
Blood Donation ◽  
Autologous Blood ◽  
Radical Retropubic Prostatectomy ◽  
Autologous Blood Donation ◽  
Preoperative Autologous Blood Donation ◽  
Retropubic Prostatectomy
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