[A new model for optimizing autologous transfusion by retrospective analysis of the transfusion requirement].
To determine the efficacy of an autologous predeposit blood program in a 2000-bed university hospital, we studied a total of 38,500 homologous transfusions administered to 8,806 patients in 1988. Only 4,170 patients were transfused; 18% of those received greater than 12 units and required 61% of all blood products, while patients with 1 to 6 units (65%) used only 22%. Patients were categorized according to similar diagnoses and therapy. For patients with elective surgery and possible predeposit blood we calculated a) the fraction of patients which presumably would not require homologous blood and b) how many of 1 to 10 predonated autologous units would not be outdated. The estimates of utilization are presented as "benefit-disadvantage-diagrams". With increasing numbers of predonations, the fraction of patients with additional needs of homologous blood decreases and the wastage rate of autologous blood increases: Favourable autologous/homologous proportions were found in orthopedic and cardiovascular surgery patients and some women with reduction mammaplasty. The "break-even" point for eligible diagnosis is set on 70 to 90% utilisation rate in patients without prospective need of homologous blood. The optimal number of predonations ranges from 3 to 8 units; depending on diagnosis, surgical patients should predeposit only in selected cases. An estimated maximum of 18 percent of all transfused patients in our hospital may thus be efficiently enrolled in a preoperative autologous blood program.
Roos
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Abt. für Transfusionsmedizin und Transplantationsimmunologie, Universitäts-Klinik Hamburg.
Kühnl
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D001804:Blood Transfusion, Autologous / Q000379:methods*; D001810:Blood Volume / Q000502:physiology*; D017707:Erythrocyte Transfusion; D006801:Humans; D012307:Risk Factors
Ein neues Modell zur Optimierung der autologen Transfusion (AT) durch retrospektive Analyse des Transfusionsbedarfs.