Safety and efficacy of unmodified whole blood vs. buffy coat‐depleted red cell concentrates in autologous transfusion of elective orthopaedic surgery patients

Abstract

Storing autologous blood as whole blood (WB) has been proposed for increasing the cost-effectiveness of preoperative autologous blood donation programmes. However, experimental data suggest that autologous leucocytes might lead to immunomodulation similar to the effect attributed to allogeneic leucocytes. In a retrospective analysis, the postoperative outcome of 120 patients undergoing elective orthopaedic surgery and having donated up to two units of autologous WB (AWB) was compared with that of a control group of 52 patients, whose autologous donation had been processed into buffy coat-depleted red cell concentrates (RCC). At least one autologous unit, but no allogeneic units, had been transfused in all analysed patients. Donation schemes were equally efficacious in both groups. There was no significant difference in postoperative infection rates between the two groups. Overall rates were 7.7% in the RCC group and 8.3% in the WB group. Surgical, thromboembolic and other recorded complications, length of postoperative hospital stay and days of the use of antibiotics were also not significantly different between the two groups. The results of this study suggest that transfusion of up to two units of unmodified AWB is as efficacious as the transfusion of autologous RCC and does not negatively influence the postoperative outcome in elective orthopaedic surgery.

Leukodepletion of autologous whole blood has no impact on perioperative infection rate and length of hospital stay

“…Either these studies were too small to detect significant differences in outcome dependent on the WBC content of autologous blood product 10,11 or a suboptimal study design was used. 12 Therefore, it was the aim of this study to provide highlevel scientific evidence based on a randomized trial investigating clinically relevant patient outcomes to ascertain whether this measure is really warranted. We hypothesized that, if a clinically relevant TRIM effect of AWB exists, then leukoreduction should result in an improved postoperative outcome, that is, a reduced perioperative infection rate and/or length of hospital stay (LOS).…”

The influence of maintaining the correct whole blood‐to‐anticoagulant ratio during donation on the quality of leukoreduced whole blood

“…Leukoreduction was one major step in the advancement of the quality of WB. Whereas leukoreduction of WB is not of clinical benefit in autologous transfusion, 23‐25 it might be beneficial in allogeneic transfusion because, in contrast to unmodified WB, 26 RBC survival of LR‐WB is comparable to that of RBCs from state‐of‐the‐art leukoreduced RBCs, 27 and labile coagulation factors are preserved during storage 13 . Thus, WB might be of value in clinical settings where disturbances of plasmatic coagulation are to be anticipated 10‐12 .…”

The cost‐effectiveness of autologous transfusion alternatives: an update and reappraisal

“…The latter is thought to be related to the leukocyte content of autologous blood 43–46 . This effect, however, has not been proven in clinical studies so far 47–49 . Furthermore, there may exist a donation‐related immunomodulatory effect which could also be of clinical relevance 50 .…”