title: Toward the elimination of homologous blood use in elective lumbar spine surgery.
abstract: Two hundred twenty-four consecutive patients underwent elective posterior lumbar spinal surgery over a 3 1/2-year span at the University of Miami/Jackson Memorial Medical Center. Patients ranged in age from 17 to 87 years, and 58% were male. Fifty-eight patients underwent revision surgery, and 65 patients required fusions, including 35 necessitating internal fixation. One hundred seventy-four patients (78%) were requested to participate in a preoperatively donated autologous blood (PDAB) program. Six of these patients were excluded from participation, and 168 patients banked 425 U of autologous blood. Eighty percent of the patients participating in the PDAB program received some or all of their donated blood. Intraoperative blood salvage was used in 37% of cases. Seven patients received homologous blood: four in addition to salvaged and donated blood, two that were unable to donate blood due to positive hepatitis B serology, and one erroneously. The combined use of PDAB and intraoperative salvage program allowed autologous blood replacement to meet the total transfusion requirements of 96% of the patients who predeposited blood, including 94% of those undergoing spinal fusions. Autologous blood comprised 99% of the total blood replacement used in this series, and 95% of the patients requiring blood transfusions received only autologous blood. Establishment of a protocol judiciously using PDAB in conjunction with intraoperative blood salvage can result in virtual elimination of the need for homologous blood transfusion in elective lumbar spine surgery.
authors.affiliation: Department of Sports Medicine and Shoulder Surgery, Maricopa County Medical Center, Arizona 85010.
authors.forename: D G
authors.initials: DG
authors.lastname: Seltzer
authors.forename: M D
authors.initials: MD
authors.lastname: Brown
authors.forename: J S
authors.initials: JS
authors.lastname: Tompkins
authors.forename: I
authors.initials: I
authors.lastname: Enger
authors.forename: F P
authors.initials: FP
authors.lastname: Cammisa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006400:Hematocrit; D006525:Hepatitis, Viral, Human / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion; D065227:Transfusion Reaction