Kurze Abnahmeintervalle bei der präoperativen Eigenblutspende im Konzept der autologen Transfusion

Abstract

Homologous transfusion is associated with infectious and immunological risks. Preoperative autologous deposit reduces homologous transfusion requirements considerably. Usually donations are carried out at weekly intervals. In this study we investigated the effect of shorter donation intervals on erythropoiesis and perioperative transfusion requirements. METHODS. A total of 40 consecutive patients scheduled for hip arthroplasty and taking part in an autologous donation programme were randomly assigned to two groups: group I gave blood on days 0, 3, 7 (and 14), group II at weekly intervals. The aim was deposit of three blood units of 450 ml. A patient was deferred if hemoglobin concentration prior to donation fell below 11 g/dl, and in this case 100 mg Fe 2+ three times daily was prescribed. Blood was stored with CP-DA-1 anticoagulant. Surgery was performed between day 28 and 35. A perioperative hemoglobin concentration lower than 9 g/dl was considered a transfusion trigger. RESULTS. Group I was made up of 21 patients (10 women, 11 men, aged 39-69 years) who gave blood at short intervals, and group II of 19 patients (10 women, 9 men, aged 37-77 years) who gave blood at weekly intervals. General data, calculated blood volume and erythrocyte mass prior to donation were comparable. Each patient donated three units. Four patients had to be deferred once, one in group I, three in group II. The hemoglobin concentration in group I decreased from 13.9 +/- 1.2 g/dl (mean +/- SD) to 13.3 +/- 1.0 g/dl prior the operation, in group II from 13.5 +/- 1.3 g/dl to 12.5 +/- 1.1 g/dl. Preoperatively the hemoglobin concentrations differed significantly (P < 0.05), as did calculated erythrocyte mass (1633 versus 1474 ml, P < 0.05). Reticulocytes increased from 46 x 10(3)/microliters (median) to a maximum of 94 x 10(3)/microliters on day 7 in group I, and from 44 x 10(3)/microliters to 108 x 10(3)/microliters in group II on day 14. Serum ferritin decreased from 122 micrograms/l (median) to 82 micrograms/l in group I, and from 140 micrograms/l to 77 micrograms/l in group II. These parameters did not differ statistically between the two groups. Intra- and postoperative blood loss amounted to 2175 ml (median) in group I versus 1430 ml in group II (P < 0.05). The perioperative hemoglobin concentration was similar in the two groups. Homologous transfusion requirements were similar in the two groups (1 unit in group I, vs 3 units in one patient and 1 unit in two patients in group II). CONCLUSIONS. Short donation intervals resulted in a higher preoperative erythrocyte mass after similar preoperative deposit, and significantly higher blood loss was tolerated with similar homologous transfusion volume.

Increased Withdrawal Volume per Deposit for Pre&ndash;Operative Autologous Blood Donation in Adolescents

“…1) most probably accounted for the statistically similar pre–operative haemoglobin level, despite only 3 weeks allotted in group A compared with 4 weeks in group B. This finding suggests a greater stimulation of erythropoiesis in group A and is in accordance with previous results where a more aggressive donation schedule using short collection intervals resulted in higher pre–operative erythrocyte mass compared with a conventional schedule [6]. …”

Die Effektivität der Eigenblutspende in der Koronarchirurgie -eine retrospektive Analyse -

“…Darüber hinaus könnte überprüft werden, inwieweit das von Wittig U. Mitarb. [39] vorgeschlagene Verfahren auch bei koronarchirurgischen Patienten einsetzbar ist. Die Untersucher gewannen unter Tolerieren niedrigerer Hämoglobinkonzentrationen initial in relativ kurzen Zeitintewallen (2-4 Tage) die erforderliche Anzahl an Eigenblutkonserven.…”

The Type of Storage of Autologous Blood Does Not Influence Homologous Transfusion Requirements in Hip Arthroplasty

“…Autologous predeposit as whole blood is an efficacious method to prevent homologous transfusion in hip arthroplasty [19,43]. Previous attempts to improve its efficacy have usually failed in the general patient population: The administration of rhEPO has yielded a larger amount of autologous predeposit but did not reduce homologous transfusion requirements [44], neither did optimized donation intervals [45]. Physicians' attitude towards transfusion influences transfusion rates considerably [46] and might also introduce a bias in favor of one of the study groups.…”