Confirmation of the safety of autologous blood donation by patients awaiting heart or lung transplantation. A controlled study using hemodynamic monitoring.
BACKGROUND
Though earlier investigations have demonstrated the efficacy of autologous blood transfusion in reducing allogeneic blood exposure in patients undergoing heart or lung transplantation, questions remain regarding the safety of blood donation by patients with severe heart or lung disease.


METHODS
Response to autologous blood donation by candidates for heart and lung transplantation and a group of age- and gender-matched control subjects was studied. Heart rate, blood pressure, oxygen saturation, and cardiac rhythm were examined before and after phlebotomy, and response to orthostatic challenge was evaluated. Patients were also questioned regarding impressions of changes in subjective sense of well being. Differences between patients and control subjects were evaluated by the paired t test and Fisher's exact test. An alpha of 0.05 was used in all testing to determine statistical significance.


RESULTS
Eighteen candidates for heart transplantation, 16 candidates for lung transplantation, and their matched control subjects were studied. Though patients and control subjects differed with respect to baseline hemodynamic measurements, significant differences between the groups' responses to phlebotomy were not observed. After whole blood donation, orthostatic challenge resulted in a mean change in mean arterial pressure of -2.1 mm Hg in candidates for heart transplantation compared with a mean of +3.6 mm Hg in their control subjects (p = 0.062). In candidates for lung transplantation there was a mean change of +2.2 mm Hg after orthostatic challenge versus a mean change of +8.5 mm Hg in their control subjects (p = 0.052). Furthermore, no changes in cardiac rhythm or arterial oxygen saturation were detected.


CONCLUSIONS
The hemodynamic effects of autologous blood donation in a group of patients with significant cardiac or pulmonary disease were not different from those observed in patients considered acceptable candidates for autologous blood collection. On the basis of these objective findings, we believe that patients with less severe degrees of heart or lung disease should not be excluded from participation in autologous blood donation programs.
Klapper
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Rita and Taft Schreiber Division of Transfusion Medicine (Department of Pathology and Laboratory Medicine) Cedars-Sinai Medical Center, Los Angeles, Calif. 90048, USA.
Pepkowitz
S H
SH
Czer
L
L
Inducil
C
C
Scott
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L
Goldfinger
D
D
D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D016022:Case-Control Studies; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology*; D016027:Heart Transplantation; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008171:Lung Diseases / Q000503:physiopathology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy / Q000009:adverse effects; D012449:Safety