Guidelines for autologous transfusion

Autologous blood donation and transfusion in Europe

BACKGROUND AND OBJECTIVES

The aim of this study was to record practices in autologous blood transfusion in Europe in 1997.

MATERIALS AND METHODS

A questionnaire mainly about predeposit was distributed to the National Representatives of all 41 member states of the Council of Europe's Committee of Experts on Blood Transfusion and Haematology. Replies were received from 29.

RESULTS AND CONCLUSION

Autologous blood units collected in 1997 amounted to 4.2% of the allogeneic units, with wide variations between countries. Predeposit was used most frequently in Italy (8.9%), Germany (7.1%) and France (6.6%). Some countries, notably Scandinavia, do not encourage predeposit, chiefly on the grounds that it is not cost-effective, but others are promoting its use.

Two-years' experience with a Canadian hospital-based autologous blood donor programme

Two years' experience with a hospital-based autologous blood donor programme is described. Of 511 patients enrolled, 86% underwent surgery without use of allogeneic blood, and 19% of collected units were not used. For six common procedures, a 'target' autologous blood schedule of 2 or 3 units (depending on the procedure) was set. If an extra unit for each of 407 patients had been collected (i.e. 3 or 4), an additional 20 patients would have been protected from exposure to allogeneic blood at a cost of 387 unnecessary collections. The difference between the mean haemoglobin (Hb) concentration at entry to the programme and the mean pre-operative Hb concentration was not clinically important and only 25 of 511 patients were deferred on account of anaemia after one or more donations. The autologous blood used represents 3.8% of the units of blood or packed red blood cells transfused during the 2 years of study. Adverse (vasovagal) reactions were infrequent (2.2%) in spite of liberal acceptance criteria.

Blood transfusion and survival in colorectal cancer

PURPOSE

This study examined the effect of blood transfusion on the prognosis of patients undergoing surgery for colorectal cancer.

METHODS

Potentially curative resections for colorectal cancer were performed in 266 patients who were followed prospectively, with a minimum follow-up of 41 months. They were divided into transfused (n = 121) and nontransfused (n = 145) groups according to their perioperative blood transfusion requirements.

RESULTS

There were significantly more rectal tumors (chi 2 = 9.5, df = 1, P = 0.002) and fixed tumors (chi 2 = 4.5, df = 1, P = 0.03) in the transfused group. There was no statistically significant difference between the two groups with regard to recurrence-free survival (chi 2 = 1.1, df = 1, P = 0.3) and overall survival (chi 2 = 2.8, df = 1, P = 0.09).

CONCLUSION

In this study we have found no statistically significant effect of perioperative blood transfusion on the prognosis of colorectal cancer patients.

Acute haemodilution in surgery for burns: a preliminary report

Blood loss is a major problem in the management of patients with burns treated by early excision and grafting. Acute normovolaemic haemodilution has been successfully used in cardiac surgery for many years but has not been reported previously in surgery for burns. The technique has been used in six patients with burns undergoing early excision and grafting, with no obvious morbidity and an apparent reduction in homologous blood requirements.

Experience of autologous blood transfusion in an obstetrics and gynaecology department

OBJECTIVE

To demonstrate the potential and effectiveness of autologous blood transfusion in an obstetric and gynaecological practice.

SETTING

The Department of Obstetrics and Gynaecology and the department of Haematology, University College Hospital, Galway, Ireland.

SUBJECTS

One hundred and sixty-eight women undergoing abdominal hysterectomy, 42 women undergoing repair procedures, and 56 women undergoing elective caesarian sections participated in this programme.

RESULTS

In the abdominal hysterectomy group 329 units of blood were collected of which 48% were transfused to the donors. In the repair group 82 units of blood were collected of which 21.9% were transfused to the donors. In the elective caesarian section group 105 units of blood were collected of which 64.7% were transfused to the donors. Overall the donation procedure was well tolerated with infrequent donor reactions.

CONCLUSION

Our experience demonstrates that autologous blood transfusion is a safe and reasonable transfusion practice in the setting of obstetrics and gynaecology.

Autologous predonation, haemodilution and intraoperative blood salvage in elective abdominal aortic aneurysm repair

The feasibility of predonated autologous blood transfusion and intraoperative blood salvage in elective abdominal aortic aneurysm repair was studied. Twenty consecutive patients were evaluated, of whom five were excluded according to protocol criteria. Patients each donated 1 unit blood 14 and 7 days before operation. A third unit was withdrawn in the anaesthetic room and replaced with Hartmann's solution, producing a haemodiluted state. Intraoperative losses were minimized using the Haemonetics Cell Saver III Plus autotransfusion system. Predonated blood from two patients passed its expiry date owing to repeated operation postponements, leaving 13 patients for study. The mean(s.d.) intraoperative blood loss was 700(300) ml with a mean(s.d.) intraoperative salvage of 420(300) ml. Two patients were transfused intraoperative salvage of 420(300) ml. Two patients were transfused according to clinical need. Thus nine patients safely avoided homologous transfusion. With autologous predonation, haemodilution and intraoperative blood salvage, elective aortic aneurysm repair can be performed safely with minimal need for homologous blood.

Predeposit autologous blood transfusion in patients with colorectal cancer: a feasibility study

Over a 2-year period, a predeposit autologous blood transfusion service was provided for all patients undergoing elective surgery for left-sided colonic or rectal cancer in one hospital. Of 129 such patients, 28 were suitable for autologous donation. Eight of these received autologous blood only, 13 required no transfusion, and seven needed additional homologous blood. Thus, although predeposit autologous transfusion for patients with colorectal cancer is possible, only a very small proportion are likely to derive any benefit which it might confer.

Safety of blood transfusion: risks and use of predonation, the Canadian experience

A variety of measures has been introduced in Canada to improve the safety of the blood supply. An autologous blood transfusion pilot study in British Columbia indicated that this form of transfusion is well tolerated and accepted in low-risk patients undergoing elective breast reconstructive surgery. While the use of autologous blood in Canada is not common at present, with broad donor criteria and increased concern about the hazards of homologous blood transfusion autologous transfusion is likely to increase in Canada in the future.

Developing techniques in blood transfusion

Expansion of transfusion medicine has led to an increasing awareness of the importance of its practice. Specialists in this branch of haematology whose main aim is to provide adequate and safe supplies of blood (and blood products) and to ensure these are used appropriately, are increasingly aware that to do this efficiently requires the development and utilization of new laboratory and technical procedures. Review of cross-matching techniques has led to the introduction of more rapid methods using low ionic strength saline. Use of monoclonal antibodies for blood grouping has made use of new technology, whilst allowing scarce human plasma to be used more appropriately for therapeutic purposes. Similarly, the implementation of a more rational approach to blood ordering, as in a maximum surgical blood-order schedule, allows for the more efficient use of donor blood. The use of microtitre plates for grouping and cross-matching techniques allows for speed and economy in the transfusion laboratory. Their use is also associated with increased automation and computer use. The possibility of using solid-phase techniques, monocyte-macrophage assays and antibody-dependent cellular cytotoxicity assays introduces new techniques differing markedly from time-honoured liquid-phase serology methods. The application of flow cytometry, which has already been shown to be useful in many aspects of haematology, is also of benefit in the field of blood transfusion science. Safety of blood transfusion is an important aspect of its practice and has led to the introduction and development of screening tests for donor blood to exclude infection risks from such organisms as HIV-1, hepatitis B and non-A, non-B hepatitis. Another approach to ensure the safety of transfused blood has been increased usage of autologous transfusion by means of both predeposit donation and intraoperative cell salvage.

Systematic pre-deposit autologous blood provision for elective surgery: an important contribution to hospital blood supply

From the 8th of September 1987 to the 31st of July 1988 all patients scheduled for major elective orthopaedic surgery were systematically offered the facility of pre-deposit autologous blood storage. Of 251 patients, 204 (81%) were eligible to pre-donate, and of these only 9 declined to do so. 72% of the participants required only autologous blood at operation, 23% required some additional homologous blood. During the study period, autologous blood accounted for 10% of all blood transfused in the district, making a significant contribution to the local blood supply.

Blood usage for elective surgery. A reappraisal of the need for autologous transfusion

To assess the need for a pre-operative autologous transfusion programme in a large teaching hospital, a review of blood cross-matching and transfusion practice for three elective surgical procedures was undertaken. For hysterectomy, the cross-match rate was 28%, and the transfusion rate only 8%. For transurethral resection of prostate and hemicolectomy, all patients were cross-matched, but only 19% and 36%, respectively, transfused. Given these figures, an autologous transfusion programme was not felt to be cost-effective. Local audit is necessary before this can be ascertained for a given district, as is consideration of the likelihood of infectious hazards in the regional blood supply.